Oncology & Hematology Coding Alert

Question: Our radiation oncologist participated in a surgery using gamma knife stereotactic radiosurgery on two lesions. Should I report 61793 two times?


Massachusetts Subscriber
Answer: Maybe - the answer depends on the services your oncologist provides. You may report 61793 (Stereotactic radiosurgery [particle beam, gamma ray, or linear accelerator], one or more sessions) per lesion, but typically if your oncologist performs this surgery with a neurosurgeon, the neurosurgeon reports 61793. The oncologist reports 77432 (Stereotactic radiation treatment management of cerebral lesion[s] [complete course of treatment consisting of one session]) instead.

Why: The Medicare Physician Fee Schedule indicates that you may not use modifiers 80 (Assistant surgeon), 62 (Two surgeons), and 66 (Surgical team) with 61793. To garner reimbursement, you need to report a procedure separate from the one the neurosurgeon performed (61793).

In the rare case that your radiation oncologist does provide the services described in 61793, remember these three tips:
  The basic rule: You may report 61793 more than once. The American Medical Association once held that you should only report the code one time, regardless of the number of lesions. After considering the extra work involved for the physician for radiosurgical planning and treatment to deal with more than one lesion in a single operative session, the AMA decided you should report 61793 per lesion.
  How to do it: Depending on your payer, append either 59 (Distinct procedural service) or 51 (Multiple procedures) to the second and subsequent report of 61793.
  NCCI pitfall: The National Correct Coding Initiative bundles reimbursement for 77432 into 61793. Translation: You shouldn't report both codes for one physician.
 
The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president, AAPC National Advisory Board.