Neurosurgery Coding Alert

Question: How should I report the use of gamma knife for lesion removal?

Oklahoma Subscriber Answer: Gamma knife techniques include both a planning and surgery phase. During the plan phase, the surgeon attaches a lightweight frame to the patient's head. With the frame in place, the patient undergoes an MRI or CT imaging study to locate the diseased area. The surgeon uses the data from the imaging study to determine the treatment plan.

During the surgery portion of the procedure, the patient is positioned on the gamma-knife couch and moved into the gamma knife to begin treatment, which can last from 15 minutes to an hour. The gamma knife employs a single, strong dose of radiation to destroy lesions. Only the tissue being treated receives the radiation, while the surrounding tissue remains unharmed.

You should report gamma surgery using 61793 (Stereotactic radiosurgery [particle beam, gamma ray or linear accelerator], one or more sessions).

The National Correct Coding Initiative (NCCI) bundles the planning phase of gamma knife surgery (+61795, Stereotactic computer-assisted volumetric [navigational] procedure, intracranial, extracranial or spinal [list separately in addition to code for primary procedure]) to the surgery itself (61793). Therefore, the surgeon cannot bill for the planning portion of the procedure if he also performed the surgical portion of the procedure.