cerebrospinal fluid leak repair cpt code

#Cerebrospinal fluid leak repair cpt code skin#
#Cerebrospinal fluid leak repair cpt code code#

The CPT Assistant, Spring 1993 describes the typical use of the secondary repair codes in two situations: 1) where a plastic/reconstructive surgeon performs the service, or 2) for repair of a postoperative cerebrospinal fluid leak. When is it Appropriate to Use the Dura Reconstruction Codes, 61618–61619?

#Cerebrospinal fluid leak repair cpt code code#

Therefore, it is not accurate to report an open skull base procedure code (61580–61616) for a procedure performed via an endoscopic endonasal approach.Ĥ. CPT guidelines also instruct physicians not to select a CPT code that merely approximates the service provided when there is not a code for the procedure performed. Therefore, it is not appropriate to report an existing skull base code for an endoscopic endonasal procedure.Īdditionally, CPT guidelines state if a procedure or service code does not exist for the procedure performed, then the appropriate unlisted procedure code should be reported. The definitive procedure codes presume an open approach as this was the standard in 1994 when the codes were written. In an endoscopic endonasal procedure, a rhinotomy for access to the skull base is not performed. “In the surgery described in this code, the nose is cut, (rhinotomy) part of the ethmoid bone is removed (ethmoidectomy), and part of the sphenoid bone is removed (sphenoidectomy) to gain access to the tumor.”

#Cerebrospinal fluid leak repair cpt code skin#

To illustrate the point about skin incisions being required, the Winter 1993 issue of the CPT Assistant states the following about the anterior cranial fossa approach code (61580) that is frequently misused to report an endoscopic procedure: Endoscopic endonasal techniques were not in use prior to 1994 when the open skull base codes were introduced into CPT. The existing skull base codes are valued for an open procedure involving major skin incisions and soft tissue dissection. The existing open (involving skin incisions) skull base surgery CPT codes were implemented in 1994, which was prior to skull base surgery being performed via an endoscopic endonasal approach (without skin incisions). Why Can't I Use 61580–61619 for Endoscopic Endonasal Procedures? Each surgeon compares their own unlisted code to the usual open skull base code(s) to determine the value/fee for the procedure.Ģ. Therefore, we have seen better reimbursement success when the ENT and NS each report different unlisted codes. But, again, practices have found reimbursement to be difficult in this scenario as payers do not seem to understand why two surgeons of different specialties are using the same unlisted code for the same procedure on the same patient. So, unlike 62165 where the ENT and NS can report the same code with modifier 62 to denote co-surgery, the two surgeons would report the same unlisted code without the co-surgery or assistant surgeon modifier. However, in reality, practices have found it difficult to obtain reimbursement when both the ENT and NS report the same exact unlisted code.ĬPT says that modifiers should not be appended to an unlisted code.

Because the skull base surgery codes are in the Nervous System section of the CPT manual, it makes sense to use that system's unlisted procedure code 64999 [ The issue becomes which unlisted code should be reported to represent an endoscopic endonasal skull base procedure. Therefore, an unlisted procedure code must be reported. For example, there are separate codes for open sinus surgery procedures versus endoscopic sinus surgery procedures.Ĭurrently, there are no other CPT codes to report a skull base procedure when performed endoscopically through an endonasal approach. This new code (62165) follows CPT's precedent of developing separate codes for endoscopic versus open approaches for performing the same procedure. Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic Up until 2003, the only code available was for a pituitary tumor removal via the traditional transnasal or transseptal approach which is reported using 61548 [ The endoscopic endonasal pituitary tumor resection code, 62165, was implemented in 2003 to provide an appropriate method for reporting pituitary tumor removal when performed endoscopically. Modifier 62 is necessary because neither surgeon performed the entire procedure him/herself. When two surgeons participate in the case together, such as the otolaryngologist performing the approach while the neurosurgeon resects the tumor, each surgeon bills 62165 appended with modifier 62 [ CPT 62165 is a stand-alone code which means it includes the approach, tumor resection and closure of the operative field. Neuroendoscopy, intracranial with excision of a pituitary tumor, transnasal or trans-sphenoidal approach

What Codes Should I Use for Endoscopic Skull Base Procedures?Ĭurrently, only one CPT code exists which describes an endoscopic endonasal approach to a skull base tumor it is 62165 [