Neurosurgery Coding Alert

Question: I receive frequent denials from our Medicare payer when reporting +61795. When I enquire which codes I can use with +61795 (which is an add-on code), the payer tells me to consult CPT. But CPT doesn't specify which codes I may report in addition to the stereotactic procedure. What should I do?

New Jersey 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 head and spine procedures, 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 (CCI) specifically bundles 61795 to stereotactic codes 61720-61799, 61863, 61867, 62201, and 63600-63621.

CPT provides virtually no instruction to help coders properly apply 61795.

Payers may react to this confusion by denying claims, with many payers particularly reluctant to reimburse for 61795 with extracranial or spinal procedures.

You should appeal such payer decisions, 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 may require one or more hours of work, such as determining the target coordinates, measuring the AC-PC line and calculating the angle.