Neurosurgery Coding Alert

Question: Our neurosurgeon has been placing gold fiducial BBs for one of the radiation oncologists here who uses them during stereotactic treatment planning for some of his patients. The physician describes placing several through a stab wound then covering them with bone wax to hold them in place. Is this something I can report?


Louisiana Subscriber


Answer: You should be reporting this procedure and might get paid for it. CPT, however, does not offer a code specific to placing these gold markers, or BBs as they-re often called. The American Association of Neurological Surgeons (AANS) recommends reporting the procedure with unlisted-procedure code 64999 (Unlisted procedure, nervous system).

Typically, the neurosurgeon places three to four markers at a time. You should report 64999 for each one.
 
Tip: When you submit your claim, include a letter explaining the procedure and reference procedure code 20660 (Application of cranial tongs, caliper, or stereotactic frame, including removal [separate procedure]) as the procedure that is closest to the service you-re reporting.

Beware: Payers often bundle 20660 into stereotactic procedures, and they may apply the same rules to 64999. But you may be able to appeal this, especially since neurosurgeons often place the markers a day or two before surgery.