Otolaryngology Coding Alert

Question: Please clarify when an ENT surgeon can charge CPT code 61795 (stereotactic computer assisted volumetric intracranial procedure [list separately in addition to code for primary procedure]). Does he or she charge the technical component, interpretive, or professional, component or the whole component? And do the hospital and physician split the fee if the hospital owns the stereotactic equipment?

Peggy Hendricks
Austin ENT Clinic, Austin, TX

Answer: Code 61795 is an add-on code, which means it is used only in conjunction with a primary procedure code. With some add-on codes involving technical procedures, a physician might have a radiologist or another physician assisting, in which case the primary physician would bill for the interpretation, or professional, component by appending modifier -26 (professional component) to the procedure code, while the radiologist would bill for the technical component. But this is not the case with 61795, which is a straight add-on procedure code that should be used in addition to the procedure code when the physician uses a computer to assist with coordinate determination established by a CT or MRI scan.

With 61795, another physician should not be involved, so there is no breakout of technical and professional components, and, therefore, no reason to append modifier
-26. Medicare will not pay for an assistant surgeon, co-surgeon or team surgeon for this procedure.

The preliminary CT or MRI, however, might require breaking out into professional and technical components, and these should be appended with a -26 modifier.

The issue of splitting fees with the owner of equipment (typically, a hospital) follows the same logic. The technical component percentage is based not only on ownership, but also on the manpower and supplies expended using the equipment. In the case of the 61795, even though the hospital owns the equipment, it is the physician who is using it and providing the manpower.

With CTs and MRIs, where the hospital owns the equipment and provides the manpower to operate it, it is deemed appropriate to split the fee into the technical and professional components. The otolaryngologist would bill for the professional component using modifier -26, and should provide a signed written report of the interpretation that is separate from his E/M or any other services.