Neurosurgery Coding Alert

Question: I receive constant denials from Medicare for 61795. When I ask which codes are appropriate for use with 61795, they tell me to consult CPT. But I can find nothing in CPT that specifies which codes I may report in addition to the stereotactic procedure. Would you help?

Texas Subscriber

Answer: Payers should accept +61795 (Stereotactic computer assisted volumetric [navigational] procedure, intracranial, extracranial or spinal [list separately in addition to code for primary procedure]) with most procedures of the head or spine, as long as the descriptor for the primary procedure does not also specify "stereotactic" (in which case, 61795 is considered integral to that primary procedure).
 
For instance, the National Correct Coding Initiative (NCCI) specifically bundles 61795 to stereotactic codes 61697, 61698, 61720-61793, 61863, 61867, 62201 and 63600-63615.
 In addition, 61795 itself includes application of cranial tongs or halo as described by 20660 and 20661, according to NCCI edits.
 
CPT provides precious little instruction to help coders on the proper application of 61795. Payers may take advantage of this situation to deny claims, and many are particularly reluctant to reimburse for 61795 with extracranial or spinal procedures.
 
You should appeal such payer decisions, however, citing the CPT definition for 61795 and the inclusion of the terms "intracranial, extracranial or spinal" in the code descriptor. Stereotactic planning represents a substantial service that requires about one to two hours and includes determination of the coordinates for the target, measurement of the AC-PC line, and angle calculation.