Neurosurgery Coding Alert

Question: Is there a separate code to describe placement of Gliadel wafers, or must I use an unlisted-procedure code? Or is this service bundled to other procedures, such as craniectomy?

Indiana Subscriber

Answer: CPT does contain a code to describe Gliadel wafer placement: +61517 (Implantation of brain intracavitary chemotherapy agent [list separately in addition to code for primary procedure]).

"Gliadel wafer" is a trade name for the dime-size discs that surgeons may place following a malignant brain tumor excision. The surgeon implants as many as eight wafers at the excision site, where they dissolve over two to three weeks and deliver the chemotherapeutic drug carmustine (BCNU) in high concentrations.

Note that 61517 is an add-on code that describes implanting the chemotherapy agent only. In addition to 61517, you must report a primary procedure code of either 61510 (Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma) or 61518 (Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor, or midline tumor at base of skull) to describe the primary surgical procedure (that is, the tumor excision).

Medicare assigns a very low physician work relative value to 61517 (equivalent to about $55), and some payers may not reimburse separately for the procedure at all. Prior to 61517's creation in 2003, many payers, and even some clinicians, argued that placement of brain intracavitary chemotherapy agents did not warrant separate payment with an unlisted-procedure code because it did not add extensively to the effort of the primary craniectomy.