Neurosurgery Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Can we append modifier -26 to 61795 and/or 69990 if they are reported with other, comprehensive codes (e.g., 61512, Craniectomy; for excision of meningioma, supratentorial)? I understand that modifier -51 is inappropriate. Washington Subscriber Answer: No modifier is necessary with +61795 (Stereo-tactic computer assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal [list separately in addition to code for primary procedure]) or +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]). Modifier -26 (Professional component) specifies the physician component of a service/procedure that has both a professional and technical component. Appendix A of CPT explains that some procedures are a combination of a physician component and a technical component. "When the physician component is reported separately," CPT further specifies, "the service may be identified by adding modifier '-26' to the usual procedure number" or by attaching the five-digit modifier code 09926. To determine if a particular CPT code contains both a professional and technical component, consult the Physician Fee Schedule. Check the far-left hand column that lists each individual CPT code. If it lists separate values for the code with modifiers -26 and -TC (Technical component), then modifier -26 is appropriate for that code if only the professional component of the service is provided (i.e., the physician does not own the equipment that he or she uses to provide the service). In the case of 61795 and 69990, each code is listed only once, indicating that neither can be further broken down into technical and professional components. Note: An updated fee schedule is announced yearly in the Federal Register and is available as a free download on the CMS Web site (www.hcfa.gov). You are correct that modifier -51 (Multiple procedures) also does not apply. When appended, this modifier implies that multiple surgical procedures subject to fee reductions have been performed. Codes 61795 and 69990 are modifier -51 exempt because they are "additional" or "add-on" procedures. If modifier -51 is appended to an add-on code for which the fee is already, reduced a further, inappropriate reduction may occur. Note: All modifier -51 exempt codes are listed in appendices "E" and "F" of CPT.