Neurosurgery Coding Alert

Make sure you append the correct modifier, or you won't see reimbursement

When a neurosurgeon performs stereotactic radiosurgery, also called gamma knife surgery, on more than one lesion, you can now report 61793 up to five times, CMS says. Follow these three tips to determine when you should report 61793 multiple times and which modifiers you-ll need to avoid denials. 

5 Separate Lesions Equals 61793 Times 5

When your neurosurgeon performs stereotactic radiosurgery, the first code you-ll report is 61793 (Stereotactic radiosurgery [particle beam, gamma ray or linear accelerator], one or more sessions). You should use this same code for brain or spinal stereotactic surgery.

The tricky part comes when the surgeon treats more than one lesion during one surgical session. Over the past few years, the American Medical Association changed its policy on how you should report multiple lesions. In the January 2006 CPT Assistant, the AMA stated that you can report 61793 multiple times if the neurosurgeon treats multiple lesions.

The article said that you report the code up to five times per session, which is new guidance, says Sharon Hathaway, RHIA, CCS-P, reimbursement manager for the department of neurosurgery at the Medical College of Wisconsin. A prior CPT Assistant article from April 2004 instructed coders to report 61793 twice if the patient had two lesions, one on the right side and one on the left side of the brain.

Remember: If you report 61793 multiple times for multiple lesions, be sure to append modifier 59 (Distinct procedural service) or modifier 51 (Multiple procedures) based on your payer's preferences. The modifier indicates to the payer that the neurosurgeon performed the procedure on more than one lesion.
 
Tip: If the neurosurgeon discovers and treats a new lesion during the original procedure's 90-day global period, append modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) to 61793, Hathaway says.

Use 61793 Only Once per Lesion

While you can report multiple lesions using 61793 multiple times, you cannot report the code more than once when the neurosurgeon performs fractionated treatments of a single lesion on the same date of service, says Corrine Fisher, MBA, CPC, clinical practice manager for the department of surgery at Yale School of Medicine in New Haven, Conn. You can use modifier 22 (Unusual procedural services) to indicate that the procedure took additional time and effort, and you may see additional reimbursement.

The January 2006 CPT Assistant article confirms this, stating, -If any lesion requires multiple isocenters and/or requires more complex targeting, then code 61793 should be reported appended by modifier 22, Unusual procedural services. Code 61793 is reported once per lesion treated whether one isocenter is used to treat the lesion or multiple isocenters are used to treat the lesion.-

Bundle 61795 and 20660

Avoid reporting +61795 (Stereotactic computer-assisted volumetric [navigational] procedure, intracranial, extracranial or spinal [list separately in addition to code for primary procedure]) and 20660 (Application of cranial tongs, caliper or stereotactic frame, including removal [separate procedure]) in addition to 61793, Fisher says.

Both the AMA and National Correct Coding Initiative edits make it clear that the planning phase of the stereotactic radiosurgery (61795) and the frame application are included in the main surgical procedure.