Laser Interstitial Thermal Therapy (LITT) Coding

Question:

I’m using LITT for epilepsy treatment.

Answer:

The codes are 61736Laser interstitial thermal therapy (LITT) of lesion, intracranial, including burr hole(s), with magnetic resonance imaging guidance, when performed; single trajectory for 1 simple lesion and 61737multiple trajectories for multiple or complex lesion(s)

*This response is based on the best information available as of 04/13/23.

CP Angle vs Skull Base Codes

Question:

I just got a case where the neurosurgeon and ENT want to bill the following codes:

ENT, 61596, Transcochlear posterior fossa skull base code for the approach.

Neurosurgeon, 61616, intradural resection of a posterior fossa skull base tumor

Is this correct? The diagnosis is a right translabyrinthine approach to cerebellopontine angle and internal auditory canal with resection of vestibular schwannoma.

Answer:

CP angle tumors, for example vestibular schwannomas, treated via a translabyrinthine approach/exposure have a CPT code that specifically describes the work and value of this approach and resection. That code is61526, Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of cerebellopontine angle tumor.The resection is essentially in the posterior fossa however, since it has a code specifically developed and valued for this procedure, code 61526 must be used. It is valued to reflect the work of this complex resection.

*This response is based on the best information available as of 03/30/23.

Coding for a Chiari Malformation

Question:

Is there a code for a craniotomy for decompression for Chiari? And the surgeon also did a C1 laminectomy.  Is that a separate code?

Answer:

The code for a decompressive craniotomy for Chiari is 61343 and includes the work of the cervical laminectomy.

*This response is based on the best information available as of 03/16/23.

Lumbar Drain in a Cranial Procedure

Question:

Can placement of a lumber drain be billed separately with a cranial procedure? I heard that placing drains is not billable.

Answer:

You are correct that placement of a drain in the surgical site/exposure is not separately billable. Placing a lumber drain via a separate incision ( in the back) during a cranial procedure is billable as it is in a separate anatomic location.

Report code 62272 if placed without fluoroscopic guidance and 62329 if fluoroscopy is used. The fluoroscopy is not separately billed.

*This response is based on the best information available as of 03/02/23.

Ruptured Aneurysm and a Hematoma

Question:

The patient present with a ruptured aneurysm. A craniotomy was performed to clip the aneurysm and the hematoma was evacuated to access the aneurysm. Are both the aneurysm clipping and the hematoma evacuation billable?

Answer:

No, the aneurysm codes are valued for ruptured or non- ruptured aneurysms and evacuating the hematoma to access and treat the aneurysm is included in the aneurysm code.

*This response is based on the best information available as of 02/16/23.

E&M Coding Based on Time

Question:

When choosing the level of E&M we are confused about the History and Exam. If we choose a level of E&M based on time, does this time count toward total time, or is it only time spent on MDM?

Answer:

When choosing a level of E&M based on time, CPT identifies the following activities as those that may contribute to total time on the date of service. As displayed below in bold font, obtaining the history and performing the exam contribute to the total time for code selection. These activities occur on the same day as the actual encounter to contribute to the level of service.

Physician/other qualified health care professional time includes the following activities when performed:

• preparing to see the patient (eg, review of tests);
• obtaining and/or reviewing separately obtained history;
• performing a medically appropriate examination and/or evaluation;
• counseling and educating the patient/family/ caregiver;
• ordering medications, tests, or procedures;
• referring and communicating with other health care professionals (when not separately reported);
• documenting clinical information in the electronic or other health record;
• independently interpreting results (when not separately reported) and communicating results to the patient/family/caregiver; and
• care coordination (when not separately reported).

source: CPT Assistant April 2022

*This response is based on the best information available as of 01/19/23.