Neurosurgery Coding Alert

Question: The surgeon decides to perform laser interstitial thermal therapy (LITT) on a lesion for a patient. In order to treat the lesion, the surgeon employs multiple trajectories. During the therapy, the surgeon also uses imaging guidance. How should I report this encounter, and can we report the imaging guidance separately from the LITT?

Montana Subscriber

Answer: No, you cannot report the imaging guidance separately. When the surgeon performs image-guided LITT on multiple or complex lesions, you’ll report 61737 (Laser interstitial thermal therapy (LITT) of lesion, intracranial, including burr hole(s), with magnetic resonance imaging guidance, when performed; multiple trajectories for multiple or complex lesion(s)). Though there was only a single lesion, it required multiple trajectories for treatment, thereby prompting 61737 as the correct code choice.

No guidance? CPT^® spells out “with magnetic imaging guidance” in the descriptors for LITT. And in the notes beneath 61736 (… single trajectory for 1 simple lesion) and 61637, CPT^® instructs coders not to report several codes, including those for guidance. CPT^® 2024 forbids reporting 61736/61737 with 20660, 61781, 70551, 70552, 70553, 70557, 70558, 70559, 77021, and 77022.