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Craniectomy for Tumor Resection
Patient had a posterior fossa craniectomy for excision of a mass which was consistent with metastatic tumor. Pathology results report the mass as a partially cystic metastatic tumor. What is the correct code 61518 or 61524?
Question:
Patient had a posterior fossa craniectomy for excision of a mass which was consistent with metastatic tumor. Pathology results report the mass as a partially cystic metastatic tumor. What is the correct code 61518 or 61524?
Answer:
The correct CPT code is 61518; a metastatic tumor is still a tumor even if it is partially cystic.
*This response is based on the best information available as of 2/27/25.
Billing Stages for Mohs
I am very confused. I am new to coding for Mohs procedures. The Mohs surgeon performed a procedure on the patient’s scalp in 5 stages. I spoke with the Mohs surgeon about billing over 4 stages in one area using CPT code 17312. He billed 17311 for the first stage and 17312 with 4 units for a total of 5 stages. In each stage, the documentation states that 1 tissue block was mapped. I think we should bill CPT 17315 for the last stage instead of 17312 since it is the 5th stage. Can you clarify if this is the case or if 17312 with 4 units is correct.
Question:
I am very confused. I am new to coding for Mohs procedures. The Mohs surgeon performed a procedure on the patient’s scalp in 5 stages. I spoke with the Mohs surgeon about billing over 4 stages in one area using CPT code 17312. He billed 17311 for the first stage and 17312 with 4 units for a total of 5 stages. In each stage, the documentation states that 1 tissue block was mapped. I think we should bill CPT 17315 for the last stage instead of 17312 since it is the 5th stage. Can you clarify if this is the case or if 17312 with 4 units is correct.
Answer:
I agree with your Mohs surgeon. The only time you use 17315 is when there are more than 5 tissue blocks per stage. Based on the information you have provided each stage indicates 1 block. CPT code 17311 should be reported for stage 1 and 17312 is reported for each additional stage (4).
*This response is based on the best information available as of 2/27/25.
Abdominal Hernia Defect Size
Our general surgeon often does not include the size of the abdominal repair in his documentation; can we use the pathology report to determine the correct size for CPT selection?
Question:
Our general surgeon often does not include the size of the abdominal repair in his documentation; can we use the pathology report to determine the correct size for CPT selection?
Answer:
No; the provider must document the hernia defect size within his/her operative report details to accurately select the correct CPT code. The pathology report would likely represent the tissue size, which would not necessarily correlate to the defect size. Best practice is to send a query to the provider asking him/her to add an addendum to the operative report, adding the defect size and advise that this information is required in the documentation.
*This response is based on the best information available as of 2/27/25.
Use of Robotic Systems During Surgical Procedures
What is the code for a robotic procedure?
Question:
What is the code for a robotic procedure?
Answer:
When surgical procedures involve the use of robotic surgical systems, the robotic component can be represented by HCPCS code S2900. However, there is no RVU associated with this code, and it is not reimbursed under the Medicare payment system. Best practice is to set a fee for the extra physician work involved with robotic assistance, document medical necessity for use of the robot and incorporate this code into billing for tracking purposes, when used.
*This response is based on the best information available as of 2/27/25.
Non-Selective vs Selective Catheterization
What is the difference between non-selective and selective catheterization?
Question:
What is the difference between non-selective and selective catheterization?
Answer:
Non-selective catheterization is when the catheter remains in the accessed vessel site (puncture site) and is not navigated further into other vessels. Selective catheterization is when the catheter is manipulated out of the access vessel, or out of the aorta, to additional vessels.
*This response is based on the best information available as of 2/27/25.
Bone Marrow Harvest for Ankle Arthrodesis
Our surgeon harvested bone from the calcaneus (same incision) and also harvested bone marrow from the iliac crest for an ankle arthrodesis. We know the bone graft from the calcaneus is not reportable. Is the bone marrow aspirate reportable? If yes, what CPT code do you recommend?
Question:
Our surgeon harvested bone from the calcaneus (same incision) and also harvested bone marrow from the iliac crest for an ankle arthrodesis. We know the bone graft from the calcaneus is not reportable. Is the bone marrow aspirate reportable? If yes, what CPT code do you recommend?
Answer:
You are correct that bone graft harvested via the same incision is not separately reportable. CPT instructs to report 20999 for the bone marrow harvest when performed for an arthrodesis in musculoskeletal system, excluding spine.
Based on your inquiry the correct code for the ankle arthrodesis is 27870 (Arthrodesis, ankle, open). Your reportable codes are 27870 and 20999.
Note, there are no NCCI edits between 27870 and 20999. Consider adding modifier 59 if necessary to indicate the bone marrow aspirate was from a different location, separate incision.
KZA recommends using 20939 as the comparison code for 20999.
*This response is based on the best information available as of 2/27/25.
