Venous Stenting for Intracranial Hypertension (ICH)

Question:

What are the most appropriate codes for venous stenting for a patient with intracranial hypertension?

Answer:

There is no specific CPT code for intracranial venous stenting. An unlisted code 64999 should be reported in addition to second order venous catheterization, 36012 and the venogram , most typically 75870, venography superior sagittal sinus. It is not appropriate to report a peripheral stenting code such as 37236. for an intracranial procedure. Code 61635 is also not appropriate as it is specifically for intracranial arterial stenting for a diagnosis of atherosclerosis.

*This response is based on the best information available as of 06/08/23.

Facet Fusion

Question:

The neurosurgeon documents a placing a cervical “facet implant or intrafacet implant “ with bone graft. Is this coded as 22600, cervical arthrodesis?

Answer:

No. This is coded with a Category III code, as shown below:

Facet Wedge or Dowel Arthrodesis (Intrafacet Implant)

Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level

• Cervical: 0219T
• Thoracic: 0220T
• Lumbar: 0221T
• Additional level: +0222T
• Includes fluoroscopy and any radiological service.
• Includes bone graft, instrumentation and arthrodesis – do not report 0219T-0221T with +20930, +20931, 22600-22614, +22840, +22853, +22854, +22859 at the same level.

*This response is based on the best information available as of 05/25/23.

Placing Methylmethacrylate around Pedicle Screws

Question:

The surgeon placed methylmethacrylate around the pedicle screw in a spine surgery. How is this coded?

Answer:

Placing methylmethacrylate to reinforce the instrumentation is included in the spine procedure.

*This response is based on the best information available as of 05/11/23.

Laser Interstitial Thermal Therapy (LITT) Coding

Question:

When using LITT treatment, can theneuronavigationand headframe placement be billed separately?

Answer:

No, neuronavigation, 61781 and headframe placement, 20660 are included and may not be billed separately.

*This response is based on the best information available as of 04/27/23.

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.