Neurosurgery Coding Alert

Warning: Watch for bundling edits with component services When reporting stereotactic radiosurgery, also called gamma knife surgery, you may assign up to five units of 61793 per claim. To take advantage of this opportunity, however, the circumstances of the surgery must meet three conditions. 1. Multiple Lesions Are a Must If your surgeon uses stereotactic radiosurgery, targeting either the brain or spine, you should automatically reach for 61793 (Stereotactic radiosurgery [particle beam, gamma ray or linear accelerator], one or more sessions) to report the procedure. Although the CPT descriptor for 61793 does not state "per lesion," the AMA has provided instructions in its CPT Assistant (January 2006, Vol. 16, No. 1, page 46) recommending that you may report up to five units of 61793 per session. This assumes, of course, that the surgeon must treat multiple lesions. In other words: You may not report multiple units of 61793 for multiple treatments on the same lesion. Instead, you may report one unit of 61793 for each separate lesion the surgeon treats, up to five lesions. "Code 61793 describes stereotactic radiosurgery of a single lesion, with one or more isocenters, treated in a single fraction or over several sessions," says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison. What if the surgeon treats more than five lesions? AMA instructions state directly that you should not report 61793 "more than five times for any session" [emphasis in original]. Therefore, even if the surgeon treats more than five lesions per date of service, you should limit yourself to no more than five units of 61793. Number of lesions matters, not number of sessions: The descriptor for 61793 does specify "one or more sessions." This is because the surgeon may have to treat the same lesion during more than one session over a period of time to safely treat it. In these cases, which are called "fractionated treatments," you should report 61793 only once per lesion, regardless of how many sessions the surgeon requires to destroy the lesion. CPT Assistant supports this coding, stating, "Code 61793 is intended to describe the physician work in treating a single lesion regardless of whether that treatment requires multiple isocenters or multiple sessions" [emphasis in original]. The article goes on to confirm, "Any additional sessions for the same lesion(s) are inclusive of code 61793." Example: The surgeon uses the gamma knife to target and destroy four spinal lesions. During an initial session, the surgeon treats two of the lesions completely but plans to fractionate treatment for two others. During a later session, the surgeon again treats the remaining two lesions. Because the surgeon treated four separate lesions, you may report [...]