Neurosurgery Coding Alert

Question: Our physician did a sublabial transseptal transsphenoidal hypophysectomy for excision of pituitary tumor with stealth. I billed 61548 and 61795. Medicare is denying because the qualifying service was not identified on this claim. What should I be reporting?


Oregon Subscriber


Answer: There is no CPT code for -stereotactic- hypophysectomy. The National Correct Coding Initiative does not bundle +61795 (Stereotactic computer-assisted volumetric [navigational] procedure, intracranial, extracranial or spinal [list separately in addition to code for primary procedure]) into 61548 (Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic), so you should be able to report the codes together and expect reimbursement.

As to your carrier's denial stating -qualifying service not identified on claim,- we were unable to find any source of documentation stating that certain codes must be reported in order for you to also apply stereotactic code 61795. There are many other procedure codes that the stereotactic service is bundled with, however.

Requiring a -qualifying service- means that your carrier's policy is, in effect, to bundle 61795 into all codes except for those on a certain -qualifying list.- This contradicts NCCI policy by attempting to supercede it, as well as a recently updated Noridian local coverage determination that specifically permits billing 61795 with 61548 when the physician establishes medical necessity.

Best bet: Appeal the carrier denial. Take note that you may have to go through more than one level of appeal to succeed.