Wiki code 61782

[maebelle@gmail.com]

We are having trouble with Medicare with our 2014 claims for stereotactic guided sinus surgeries. We bill the stand-alone codes for the endoscopic sinus procedures along with the add-on code of 61782 (stereotactic computer-assisted navigational procedure; cranial, extradural). Medicare is the only insurance that is not paying for this code. Their denial reason states " The related or qualifying claim/service was not identified on this claim. Note; Refer to the 835 Healthcare Policy Identfication Segment (loop 2110 Service Payment Information REF) if present." Is anyone else having trouble with this code? We did not have problems until January 2014...my thoughts are that it is being denied in error by Medicare.

 

[OCD_coder]

It is a CPT rule and a MCR rule that you cannot bill the 61782 by the same surgeon performing the primary surgery at the same surgical session; this applies to he sinus endoscopies you are describing here in the forum.

Parenthetical Notes CPT Surgery Guidelines 2014
(Do not report 61781, 61782 by the same individual during the same surgical session)

 

[maebelle@gmail.com]

My interpretation of the parenthetical phrase "(Do not report 61781, 61782 by the same individual during the same surgical session)" is that those two specific codes should not be reported together by the same physician during the same surgical session, not that a physician can't report it during a surgery. It is an add-on code so it has to be reported with a stand-alone code. Thoughts???

 

[rjh977@vc]

it is a cpt rule and a mcr rule that you cannot bill the 61782 by the same surgeon performing the primary surgery at the same surgical session; this applies to he sinus endoscopies you are describing here in the forum.

parenthetical notes cpt surgery guidelines 2014
(do not report 61781, 61782 by the same individual during the same surgical session)

that is not medicare's denial though. And commercial payers will pay for it.

 

[rjh977@vc]

my interpretation of the parenthetical phrase "(do not report 61781, 61782 by the same individual during the same surgical session)" is that those two specific codes should not be reported together by the same physician during the same surgical session, not that a physician can't report it during a surgery. It is an add-on code so it has to be reported with a stand-alone code. Thoughts???

that's the way i understood it also. The publication i mentioned has it clearly listed as not having specific primary codes-type 1 and type 3 do have specific codes. I think they have a code edit issue. Thanks for your input

 

[JenniferB7]

The surgeon performing the procedure can bill 61781 OR 61782 - NOT both codes.

From the CPT Assistant, July 2011 Page: 12-13 Category: Stereotactic Computer-Assisted (Navigational) Procedures"

Code 61782 is reported for stereotactic computer-assisted (navigational) procedures for the cranial, extradural region. It is reported in addition to the primary procedure code, either open or endoscopic. A parenthetical note indicates that codes 61781 and 61782 should not be reported by the same provider during the same surgical session.

Question:
When are codes 61781, 61782, and 61783 reported?

Answer:
Code 61781 is reported when stereotactic computer-assisted navigation is used with primary procedures that are performed in the cranial, intradural region. Code 61782 is reported when performed in conjunction with otolaryngologic/head, and neck (craniofacial) procedures, including functional endoscopic sinus surgeries (FESS) and skull base resection codes. Examples include the procedures described by codes 31254-31256, 31267, 31276, 31287, 31288, 31290-31294, and 61548. Code 61783 is reported with primary procedures performed in the spinal region such as the placement of fixation devices requiring precision (eg, C1-C2 screws) or a complex tumor resection.

Question:
Who reports stereotactic computer-assisted (navigational) procedures?

Answer:
Neurosurgeons, otolaryngologists, orthopedists, and spine surgeons report codes 61781, 61782, and 61783 when this type of navigation is needed for the procedure and the patient.

Question:
How many units of code 61782 may be reported during a single operative session involving multiple endoscopic sinus procedures?

Answer:
CPT code 61782 is reported once per surgical session, regardless of the number of sinuses involved. The code includes planning, setup of the instrument, and its intraoperative use. CPT codes 61783 and 61784 are also reported only once per surgical session.

References

1. American Medical Association. CPT Changes 2011. 2010; Chicago, IL; 2011; pp. 98-101.

2. American Medical Association. RBRVS 2011 Data Manager. 2010; Chicago: IL.

CPT Assistant* ©*Copyright 1990-2011, American Medical Association. All rights reserved.​

Hope that helps!