Neurosurgery Coding Alert

Question: What codes are appropriate for the markers, stereotactic frame, burr hole, implantation of the electrodes, mapping and the use of the stereotactic computer and creation of a lesion when the neurosurgeon implants the deep brain stimulation lead and generator? Neurosurgery Discussion Group Participant Answer: Mapping will occur prior to implantation and should be reported using 95961 (Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of physician attendance) and +95962 ( each additional hour of physician attendance [list separately in addition to code for primary procedure), as necessary. Because 95961 and +95962 are time-based codes, be sure to document carefully the time the physician dedicates to the mapping. And, because the physician provides interpretation only, modifier -26 (Professional component) must be appended to any/all units of 95961 and +95962. Code 61862 (Twist drill, burr hole, craniotomy, or craniectomy for stereotactic implantation of one neurostimulator array in subcortical site [e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray]) describes implantation of electrodes through burr holes with stereotactic placement. Note that the national Correct Coding Initiative considers placement of the stereotactic headframe (20660, Application of cranial tongs, caliper, or stereotactic frame, including removal [separate procedure]) and stereotactic guidance (+61795, Stereo-tactic computer assisted volumetric [navigational] procedure, intracranial, extracranial or spinal [list separately in addition to code for primary procedure]) integral to 61862, and therefore they may not be reported separately. Note: Some third-party payers may allow separate reimbursement for 20660, +61795 and 61862. Check with the specific payer for guidelines. Placement of the generator is reported 61885 (Incision and subcutaneous placement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array). If the generator is implanted on a date subsequent to implantation of electrodes, modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) must be appended to 61885 to indicate that a return to the operating room was necessary and prospectively planned to complete a staged procedure. Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno.