Oncology & Hematology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: Who bills for the application of the headframe? The neurosurgeon bills 61793 for stereotactic radiosurgery, but can the facility charge separately for 20660 when the nurse deploys the headframe screws? Would 61105 be a better code?

Nevada Subscriber

    Answer: Code 20660 (application of cranial tongs, caliper, or stereotactic frame, including removal [separate procedure]) is bundled into the service described by 61793 (stereotactic radiosurgery [particle beam, gamma ray or linear accelerator], one or more sessions). In the hospital, the same bundling method applies to ambulatory classification payments (APCs), so no separate reimbursement would be made for the headframe application.
 
CPT coding guidelines state that codes described as a "separate procedure" are not reported in addition to the code for the primary service. They are an integral component of the major service. Code 61105 (twist drill hole for subdural or ventricular puncture) describes a more complex service than the application of a headframe and would not be appropriate for a service provided by nonphysician medical staff. There is no "incident to" provision in the hospital, and 61105 would not meet the criteria for an incidental procedure in the office or freestanding center.