Orthopedic Coding Alert
Expect Carrier Resistance to 61795
Question: Our surgeon used stereotactic navigation (61795) during laminectomy with fusion, along with instrumentation and cage placement, but the payer refused to pay the add-on code. Should we appeal? Answer: According to CPT, +61795 (Stereotactic computer-assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal [list separately in addition to code for primary procedure]) is an add-on code describing stereotactic computer-assisted volumetric (navigational) procedure, intracranial, extracranial or spinal (emphasis added).
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In addition, the National Correct Coding Initiative (NCCI) does not bundle 61795 to the laminectomy/fusion or instrumentation codes. Finally, stereotactic navigation allows the surgeon to place pedicle screws without damaging neuro/vascular tissues and thus reduce the risk of the surgery.
For these three reasons, the insurer should honor your claim for 61795 in this case, although many carriers may be hesitant to pay for such navigation with spinal procedures. You should appeal the insurer's decision, citing the CPT definition for 61795 and the inclusion of "spinal" in the code descriptor.
You should also request that the insurer's medical policy director review the claim.
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