Neurosurgery Coding Alert

Question: Are the endoscopic codes (62161-62165) replacement codes or add-on codes? For instance, does 62165 replace 61548 if the surgeon performs the procedure endoscopically, or should I use 62165 and 61548?

Texas Subscriber

Answer: The only neuroendoscopy code CPT lists as an add-on code is +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]). You should report 62160 in addition to codes 61107, 61210, 62220, 62223, 62225 and 62230 only.

The remaining neuroendoscopy codes (62161-62165) are "primary" procedures. That is, they do not describe an "extra" step above and beyond the related open (incisional) procedures, but are meant to take the place of the open code if the surgeon performs the surgery endoscopically.

To answer your question, then, you would not report 61548 (Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic) and 62165 (Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or trans-sphenoidal approach) at the same time. These codes describe two different methods to achieve the same end (removal of pituitary tumor), and you must select one or the other. If the surgeon used the neuroendoscope to remove the tumor, you should report only 62165.