It is not appropriate to report 15750 (Flap neurovascular pedicle) for a nasolabial flap. CPT says the following about 15750: “This code includes not only skin, but also a functional motor or sensory nerve(s). However, if graft material is harvested through a separate surgical exposure, then a separate graft harvest code may be reported. A return to the operating room subsequent to the initial procedure, for repair of a CSF leak, may be separately reported.Īdditionally, CPT guidelines include surgical wound closure in the open resection/excision definitive procedure skull base code. ![]() Do not use codes such as 61618 or 61619 (secondary repair of cerebrospinal fluid (CSF) leak codes) as a comparison or base code for the unlisted code billed. The ORL fee for 31299 would include his or her assistant surgeon activity (modifier 80 or 82) on the NS’s base code.Ĭlosure of the dura is included in the unlisted procedure code reported just as it is part of the usual skull base surgery definitive procedure codes (e.g., 61601). For example, the base code might be 61580 (Craniofacial approach to anterior cranial fossa extradural, including lateral rhinotomy, ethmoidectomy, sphenoidectomy, without maxillectomy or orbital exenteration) for the above example of the clival chordoma endoscopic resection. Use a “base” or similar existing comparison CPT code to determine the ORL’s fee for 31299. The otolaryngologist reports 31299 (Unlisted procedure, accessory sinuses) for his or her portion of the procedure and this code encompasses the ORL’s work of the transnasal approach, entering the skull base, but not the dura, assisting the neurosurgeon during the dural opening and tumor resection, and then performing the closure using a local flap. In this scenario, the ORL assists the NS by holding the endoscope and vice versa. Consider an endoscopic transnasal approach to the anterior cranial fossa, intradural resection of a clival chordoma, with dura repair and septal flap closure. Also, CPT guidelines state it is not appropriate to append a modifier to an unlisted code because an unlisted code does not describe a specific procedure.īecause each surgeon is performing his or her own separate procedure in endoscopic/endonasal skull base surgery, much like in the use of the existing skull base surgery codes, we recommend each surgeon report his or her own unlisted CPT code (ORL–31299, NS–64999). It is not accurate to report individual component codes (e.g., endoscopic sinus surgery, septoplasty) instead of an unlisted code for endoscopic skull base surgery as this is not in line with CPT coding guidelines.Įach unlisted CPT code is used to describe the actual work by each surgeon. We have found that many payers fail to recognize, and appropriately reimburse, claims where both surgeons report the same unlisted code with modifier 62 (e.g., 64999-62). Many otolaryngology and neurosurgery practices have implemented a successful coding and reimbursement strategy for performing endoscopic skull base surgery procedures together. Both the AAO-HNS and the American Association of Neurological Surgeons agree it is not accurate to use the existing skull base surgery CPT codes for endonasal/endoscopic procedures because the existing codes describe an open procedure involving skin incision(s). Therefore, endonasal/endoscopic skull base procedures, except the endoscopic resection of a pituitary tumor (62165), do not have a CPT code. Endonasal/endoscopic skull base surgery is relatively new and performed in a limited number of organizations. ![]() The existing open (involving a skin incision) skull base surgery CPT codes were introduced to the CPT code system in 1994. ![]() Modifier 62 (two surgeons) is appended to 62165 when performed as co-surgery involving the otolaryngologist (ORL) and neurosurgeon (NS) to show that neither surgeon performed the entire procedure code. Only one CPT code exists for an endoscopic skull base procedure-62165, Neuroendoscopy, intracranial with excision of a pituitary tumor, transnasal, or trans-sphenoidal approach. Unlike the skull base surgery codes that include separate codes for the approach and definitive procedure, CPT 62165 includes the approach, tumor resection, and closure. The contemporary practice of medicine is occasionally ahead of the CPT code system and an accurate code may not always exist for the procedure performed this is true for reporting most endoscopic/endonasal skull base surgery procedures.Coding Issues The American Medical Association’s Current Procedural Terminology® (CPT) codes for reporting medical services and procedures performed by physicians must be used to bill services to third party payers. Coding and Reimbursement Strategies: Using an Unlisted Code for Endoscopic Skull Base Surgery
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