Neurosurgery Coding Alert

Question: Our neurosurgeons are involved with the radiation oncologists for the planning and image studies phase of stereotactic radiosurgery. They review the images, decide on the amount of radiation to administer, and so on. The patient is not present during this planning phase. If and when the neurosurgeon is not present for the administration of the radiation or treatment session, can we still bill 61793? If not, is there another code we can bill for the neurosurgeons portion of this service?

Massachusetts Subscriber

Answer: If the patient is not present and the neuro-surgeon does not participate in the radiation treatment delivery, you should not report the stereotactic radio-surgery code. To report a code, the neurosurgeon must be active throughout the planning and the treatment.

If youve got stellar documentation depicting the neurosurgeons involvement during both planning and treatment, you could report either 61796 (Stereotactic radiosurgery [particle beam, gamma ray, or linear accel-erator]) 1 simple cranial lesion) or 61798 (& 1 complex cranial lesion). CPT 2009 deleted 61793 (Stereotatic radiosurgery [particle beam, gamma ray, or linear accelerator] one or more sessions).

How do you determine if a lesion is simple (61796) or complex (61798)? A "simple" cranial lesion is less than 3.5 cm in maximum dimension, according to CPT guidelines. Any lesion 3.5 cm in maximum dimension or larger is considered "complex." In addition, the AMA classifies a lesion as complex if it is adjacent (5 mm or less) to the optic nerve, optic chiasm, optic tract, or brainstem. Payers will consider certain types of lesions, regardless of size and proximity to sensitive structures, as complex lesions (such as arteriovenous malformations and pituitary and pineal tumors)