Part B Insider (Multispecialty) Coding Alert

Published on Sat Jun 24, 2006 PDF

Question: If our neurosurgeon performs stereotactic radiosurgery, is it true that he can report 61793 on more than one lesion, up to five times? Do you have any examples of when this rule would apply?


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Answer: Yes, your neurosurgeon can use 61793 for multiple lesions, but the catch to reporting the code up to five times depends on whether she treats more than one lesion during one surgical session.

Remember: If you report 61793 multiple times for multiple lesions, be sure to append modifier 59 (Distinct procedural service) or modifier 51 (Multiple procedures) based on your payor’s preferences. The modifier indicates to the payer that the neurosurgeon performed the procedure on more than one lesion.

Tip: If the neurosurgeon discovers and treats a new lesion during the original procedure’s 90-day global period, append modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) to 61793, says Sharon Hathaway, RHIA, CCS-P, reimbursement manager for the department of neurosurgery at the Medical College of Wisconsin.

Beware: While you can report multiple lesions using 61793 multiple times, you cannot report the code more than once when the neurosurgeon performs fractionated treatments of a single lesion on the same date of service, says Corrine Fisher, MBA, CPC, clinical practice manager for the department of surgery at Yale School of Medicine in New Haven, CT. You can use modifier 22 (Unusual procedural services) to indicate that the procedure took additional time and effort, and you may see additional reimbursement.

The January 2006 CPT Assistant article confirms this, stating, “If any lesion requires multiple isocenters and/or requires more complex targeting, then code 61793 should be reported, appended by modifier 22, Unusual procedural services. Code 61793 is reported once per lesion treated whether one isocenter is used to treat the lesion or multiple isocenters are used to treat the lesion.”