The latest version of the national Correct Coding Initiative (CCI), version 6.2 of the Healthcare Financing Administrations (HCFA) Correct Coding Manual, bundles code 61795 (stereotactic computer assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal [list separately in addition to code for primary procedure]) to most, but not all, endoscopic sinus surgeries, as well as to turbinate resection (30140), fracture (30930), and septoplasty (30520).
At the time of writing, HCFA has yet to announce an effective date for implementation of version 6.2. The edits to 61795 are a serious reimbursement change,
otolaryngology coding experts contend. Otolaryngologists who use InstaTrak the brand name for the stereotactic image guidance system when performing the procedures to which 61795 will be bundled, find their billing choices limited.
InstaTrak uses an electromagnetic tracking system that builds a computerized model of the patients skull anatomy with CT scans prior to surgery. During the surgery, the patient is fitted with a headset that aligns the images taken by the endoscope with the presurgical model of the patients anatomy. This allows the otolaryngologist to see around corners and better locate surgical instruments in relation to the patients surrounding anatomy tasks that cannot be performed using the endoscope alone.
The increasing use of this system is a prime reason for the bundling of 61795. Another reason is the codes descriptor, which more appropriately defines stereotactic image guidance during deep brain procedures and other services more complicated than its use in sinus surgery.
Because the procedure was valued with more complicated services in mind, and because more and more physicians claim for the service, the CCI edit does not come as a complete surprise, says Lee Eisenberg, MD, an otolaryngologist and member of CPTs editorial panel and executive committee.
Since the use of InstaTrak has become routine for many otolaryngologists, Medicare (and private) carriers may view the service as an integral part of the primary procedure performed, Eisenberg speculates, and may have determined that the increasing number of claims (at a payment amount originally meant for deep brain surgery) constitutes abuse.
Code 61795 was valued so high, much like code 69990 (use of operating microscope [list separately in addition to code for primary procedure]), that these codes sometimes paid more than the primary services they were being used for, Eisenberg says, adding that carriers often deny payment for add-on codes because they cannot be deemed as multiple procedures and therefore they cannot reduce the fee.
Note: According to the 2000 National Physician Fee Schedule Relative Value Guide, 61795 was assigned 8.98 RVUs, whereas, for example, 31254 (nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior]) was valued at 7.71 RVUs.
On the other hand, he also notes that the [...]
