Neurosurgery Coding Alert

CPT 2003 has added a code to report separate placement of brain intracavitary chemotherapy agents: +61517 (Implantation of brain intracavitary chemotherapy agent [list separately in addition to code for primary procedure]).

Specifically, the code refers to placement of Gliadel Wafers dime-sized disks containing the chemotherapeutic drug carmustine (BCNU) following excision of a brain tumor. The surgeon implants as many as eight wafers at the site of the excision, where they dissolve over a period of two to three weeks and deliver BCNU in high concentrations. As noted in CPT Changes 2003, prior to this time, "the only codes available for reporting cerebral chemotherapy described chemotherapy when administered intravenously, subarachnoid or intraventricular via a subcutaneous reservoir," none of which properly described placement of intracavitary wafers. Note that 61517 is an add-on code describing implantation of the chemotherapy agent only, and that it must accompany 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, i.e., tumor excision. Note: For more information on reimbursement for Gliadel Wafers, contact the Guilford Pharmaceuticals case management and reimbursement assistance program (CaRe) toll-free at (877) 909-2337.