Neurosurgery Coding Alert

Blood-brain barrier disruption (BBBD) therapy allows for treatment of brain tumors without the need for surgery or potentially damaging radiation therapy. But CPTcontains no specific code to describe this service. By reporting all the component services of BBBD, however, you can significantly increase your chance for fair reimbursement. Lower the Barrier The blood-brain barrier is a semipermeable barrier formed by a layer of cells surrounding the blood vessels that feed the brain, says David Peereboom, MD, of the Brain Tumor Institute at the Cleveland Clinic in Cleveland. The barrier limits the transfer of potentially damaging substances from the bloodstream to the brain and spinal cord. Although the blood-brain barrier performs an important protective function, it also prevents chemotherapeutic agents from entering the brain, thereby limiting treatment options for brain tumors, Peereboom says. BBBD therapy temporarily breaks down the blood-brain barrier. Specifically, the physician injects Mannitol to shrink the cellular lining of the capillaries that form the blood-brain barrier, allowing chemotherapy drugs injected via the internal carotid artery to enter the brain. The technique is called hyperosmotic blood-brain disruption (HBBD). BBBD therapy (along with the use of chemotherapeutic agents) provides a less-damaging alternative to surgical intervention or radiation therapy while also delivering higher concentrations of medication to the brain, Peereboom says. Track All Codes over Several Days Typically, BBBD therapy occurs over several days, Peereboom explains. The patient is admitted to the hospital and undergoes diagnostic testing, including a CT scan or magnetic resonance imaging (MRI) of the head, as well as blood work. These tests determine the tumor's progression or regression and therefore the patient's eligibility for therapy.                                                                   On the initial day, the surgeon should claim a hospital admission (99221-99223 as appropriate) for the initial patient evaluation and ordering of tests. If the surgeon interprets the MRI or CT scan, he or she may report the appropriate code with modifier -26 (Professional component) appended. Applicable codes for CT scans include 70450 (Computed tomography, head or brain; without contrast material), 70460 ( with contrast material[s]) or 70470 ( without contrast material, followed by contrast material[s] and further sections).The MRI codes are 70551 (Magnetic resonance [e.g., proton] imaging, brain [including brain stem]; without contrast material), 70552 ( with contrast material[s]) or 70553 (... without contrast material, followed by contrast material[s] and further sequences), depending on whether the surgeon employs contrast and/or further sequencing.                    On the second day, the patient is placed under general anesthetic in the operating room. The surgeon threads a catheter through the femoral artery to a carotid or vertebral artery. He or she infuses the patient with mannitol, via the catheter, into the artery to open the blood-brain barrier and injects the chemotherapeutic agent. The patient undergoes a CT [...]