Neurosurgery Coding Alert

Question: How should I code a stereotactic craniotomy with application of a headframe, MRI, CT scan and microscope for biopsy of a bithalamic mass?
                
Pennsylvania Subscriber  
Answer: If only one access was made, use 61751 (stereotactic biopsy, aspiration, or excision, including burr hole[s], for intracranial lesion; with computerized axial tomography and/or magnetic resonance guidance). Some non-Medicare payers will allow the separate placement of the head frame (20660, application of cranial tongs, caliper, or stereotactic frame, including removal [separate procedure]) with this procedure, so you should ask your local carrier. Magnetic resonance imaging (MRI) and computerized tomography (CT) are included in 61751.
 
Code 70450 (computerized axial tomography, head or brain; without contrast material), 70460 ( with contrast material[s]) or 70470 ( without contrast material, followed by contrast material[s] and further sections) should be added as appropriate, as they are not bundled into 61751 in the current version (7.3) of the national Correct Coding Initiative.
 
If separate craniotomies are performed to biopsy the bithalamic mass, report 61751-51-RT (... multiple procedures; right side). Compensation for this second procedure is likely to be reduced by as much as 50 percent.
  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.