Sunday, March 20, 2011

CPT code 61782, 53860, 57156, 61781 - Stereotactic Procedure

New CPT Codes

61781 - Stereotactic Computer Assisted PX IDRL CRNL
61782 - Stereotactic Computer Assisted PX XDRL CRNL
61783 - Stereotactic Computer Assisted PX SPINAL
64566 - POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE
64568 - INC IMPLTJ CRNL NRV NSTIM ELTRDS & PULSE GENER
64569 - REVISION/REPLMT NSTIM CRNL ELTRDS
64570 - REMOVAL CRNL NRV NSTIM ELTRDS & PULSE GENERATOR
64611 - CHEMODENERV PAROTID & SUBMANDIBL SALIVARY GLANDS BI


Overview

Recent advances in technology have led to numerous advances in imaging technology, more specifically for the purposes of this policy, imaging as related to surgical procedures. This policy is intended to cover those uses of  stereotactic computer assisted volumetric and or navigational procedures which could correctly be identified by theuse of CPT codes 61781, 61782 and 61783 (add-on codes), recognized for payment by Medicare, when their use is considered medically reasonable and necessary. An add-on code is a HCPCS/CPT code that describes a service that is always performed in conjunction with another primary service. An add-on code is eligible for payment only if it is reported with an appropriate primary procedure performed by the same practitioner. An add-on code is never eligible for payment if it is the only procedure reported by a practitioner.

Guidelines

Payment is limited to CPT codes 61781, 61782 and 61783 for any one or more of the following indications:

** Where there is clinical data to support its use.

** When used in conjunction with most intracerebral procedures, excluding routine shunt procedures.

** When used for the following extracranial otorhinolarngological/head and neck procedures:

o Revision endoscopic sinus surgery

o Frontal or sphenoid sinus surgery when there is documented loss of or altered anatomic and marks, congenital deformities or severe trauma

o Significantly distorted sinus anatomy of developmental, postoperative or traumatic origin

o Extensive sino-nasal polyposis of sufficient severity to create a need for the precision localization and navigation assistance

o Pathology involving the frontal, posterior ethmoid or sphenoid sinuses

o Disease abutting the skull base, orbit, optic nerve or carotid artery

o Lateral skull base surgery where navigational planning and assistance is required

o CSF rhinorrhea or conditions where there is a skull base defect

o Transsphenoidal surgery

o Benign and malignant sino-nasal neoplasms of sufficient size or high-risk location Use of CPTs 61781, 61782 and 61783 with 20985, 0054T and 0055T or other such CPT codes have been determined to be NOT appropriate in cases where screws and/or other hardware are applied to the spine. All spinal procedures will be considered inappropriate for its separate payment, due to the lack of compelling literature support, and such claims will be denied as not proven effective.

In addition, there is currently no convincing literature to support the use of any other clinically-available devices for use in performing joint replacement surgery, either knee or hip. Though it does appear that the technology allows arguably more precise positioning of the joint replacement hardware, there is no long-term data supporting the assertion that this improves patient outcomes or long-term viability of the repair as compared to traditional methods of performing these procedures. Therefore, CPT codes 20985, 0054T and 0055T, or other such CPT codes will be denied as not proven effective.Documentation Guidelines When medically reasonable and necessary, the use of a stereotactic guidance system may be reported in addition to the intracranial (primary) procedure code.

The use of a stereotactic guidance system may be reported in addition to the endoscopic sinus (primary) surgery code and lateral skull base procedures in appropriately select cases to provide localization and navigation around high-risk anatomical areas when there is documentation of both the medical necessity and the required pre-planning activities. When codes 61781, 61782 and 61783 are billed in conjunction with any of the primary CPT codes, it is expected that documentation will demonstrate both the added work involved in the use of this procedure and the medical necessity for its use when done in conjunction with the primary surgery performed. Failure to document both the description of the use of the stereotactic procedure and the medical necessity for its use may result in denial of claims for CPT codes 61781, 61782 and 61783.

Documentation must substantiate the high-risk clinical circumstances requiring the precision localization and navigation assistance which the computer guidance provides. Documentation of the pre-planning activities should also provide evidence the procedure has included the work described in the CPT reference noted above. As a logical extension of the advice in the preceding paragraphs, CPT Codes 61781, 61782 and 61783 are not separately reportable if it is just used for intraoperative localization. The physician must not report the use of imageguided technology for the navigation system used as a routine part of any surgery.

The medical record must be made available to UnitedHealthcare upon request. When the documentation does not meet the criteria for the service rendered or the documentation does not establish the medical necessity for the services, such services will be denied as not reasonable and necessary under Section 1862(a)(1) of the Social Security Act. When requesting a written redetermination, providers must include all relevant documentation with the request. CPT Codes 61781, 61782 or 61783



Computer-assisted Stereotactic Navigational Procedures for Cranial and Spinal Procedures

Effective May 21, 2012, we follow CPT/CPT Assistant direction for coding edits associated with CPT Codes 61781, 61782, and 61783. The CPT direction is as follows:

• Do not report 61781 in conjunction with codes 61720-61791, 61796-61799, 61863- 61868, 62201, 77371-77373, or 77432.

• Do not report 61781 and 61782 by the same health care professional during the same surgical session.

• Do not report 61783 in conjunction with 63620 or 63621.

• Do not report 61781-61783 in conjunction with 20660.

• Do not report 61796-61799 in conjunction with 61781-61783.

For any code pair not listed above, we follow NCCI Incidental and Mutually Exclusive edits. Computer-assisted Surgical Navigational Procedures For Musculoskeletal

Procedures


Separate reimbursement is not provided for Computer-Assisted Surgical Navigational Procedure for Musculoskeletal Procedures (CPT codes 20985, 0054T, and 0055T) as it is considered incidental to the primary overall service.


Deleted CPT codes

61795 - Stereotactic computer-assisted volumetric (navigational) procedure, intracranial, extracranial, or spinal (List separately in addition to code for primary procedure)
64573 - Incision for implantation of neurostimulator electrodes; cranial nerve

Urinary System – 1 New Code

53860 - Transurethral Radiofrequency Treatment for Stress Incontinence

Female Genitourinary System – 1 New Code

57156 - Insertion of Vaginal Brachytherapy Device

Nervous System – 8 New & 2 Deleted codes

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