Neurosurgery Coding Alert

Question: Our surgeon attempted to remove a pituitary tumor using the endoscope (62165). During the initial approach, however, she decided that progressing with the endoscope was too risky. She removed the endoscope and removed the tumor via incisional transseptal approach. How should I report this?

Michigan Subscriber

Answer: If the surgeon needs to "convert" an endoscopic procedure to an open procedure because of complications or other difficulties, you should report only the code for the successful (open) procedure. In this case, therefore, you must report only the "open" procedure, using 61548 (Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic).

Because the surgeon began with an endoscopic procedure, you may be tempted to report 62165 (Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or transsphenoidal approach) with modifier 53 (Discontinued procedure) in addition to 61548, but this is incorrect.

Bottom line: As long as the surgeon completes the service, you should bill the successful procedure only. You won't normally report endoscopic and open codes together during the same operative session.

Important exception: When reporting +62160 (Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage [List separately in addition to code for primary procedure]) to describe endoscopic placement of a ventricular catheter, you must choose a primary procedure to accompany the endoscopic code. Code +62160 describes only the additional work of neuroendoscopic assistance.

Allowable primary procedure codes for +62160 include 61107, 61210, 62220, 62223, 62225, 62230, and 62258, according to CPT guidelines.