Do you know the appropriate code to report a craniotomy? Let us help you avoid claim denials! Overall, there is only a 1% chance of a person developing a malignant brain tumor. However, these abnormal growths have a lasting and life-altering impact on an individual’s life, more so than any other cancer. With over 1.3 million Americans living with a primary or secondary brain tumor, neurosurgeons are in high demand.
However, many professionals lack the essential coding skills or competent billing staff to manage the ever-changing requirements. Are you also struggling to describe a neurosurgical procedure accurately? Let’s simplify CPT code 61510, a popular code for bone flap craniotomy performed specifically to remove a tumor in the supratentorial region of the brain.
CPT Code 61510 – Description
CPT code 61510 refers to a widely performed neurosurgical procedure: craniectomy or craniotomy for the excision of a brain tumor. More specifically, billing specialists use this code when a neurosurgeon removes a portion of the skull bone to excise a brain tumor, excluding meningiomas — the most common type of primary brain tumor.
This procedure is typically performed in the supratentorial region of the brain (the area above the tentorium cerebelli, which contains the cerebrum). The most common types of tumors in this part of the brain include:
- Astrocytomas
- Gangliogliomas
- Dysembryoplastic neuroepithelial tumors
- Oligodendrogliomas
In short, healthcare providers use CPT code 61510 to document and bill for:
- Creating a bone flap (temporarily removing a portion of the skull)
- Excising a tumor in the supratentorial region
- Replacing the bone flap at the end of the procedure (Depends on the situation. The doctor may choose not to replace it.)
Scenarios Where CPT Code 61510 is Applicable
Here are a few specific and detailed scenarios where CPT code 61510 is applicable:
Removal of Pleomorphic Xanthoastrocytoma (PXA)
Let’s consider the removal of a Grade 1 astrocytoma! Suppose a 10-year-old girl is brought to a neurosurgeon. Her parents report that she has been suffering from seizures. The doctor conducts an MRI scan and several other tests to determine the cause.
The test results reveal a pleomorphic xanthoastrocytoma (PXA) — a rare type of astrocytoma characterized by fluid-filled cysts within solid tissue — located in the patient’s temporal lobe. The surgeon performs a craniotomy to remove as much of the tumor as possible using specialized tools.
Since this procedure is performed in the supratentorial region, the neurosurgeon bills it using CPT code 61510.
Removal of a High-Grade Glioblastoma
Did you know that glioblastoma (GBM) is the most common and aggressive type of brain cancer, accounting for 50.1% of all primary malignant brain tumors? Let’s look at a real-world scenario!
Suppose a 64-year-old patient experiencing frequent headaches and nausea visits a neurologist. Upon evaluation, the doctor notes cognitive decline and loss of appetite over the past few months.
To investigate further, the neurologist orders an MRI scan. The test results reveal a cystic lesion with an enhanced rim in the frontoparietal region. This leads the doctor to suspect a high-grade glioma, specifically glioblastoma (GBM).
He decides to excise this tumor via craniotomy and then sends the removed tissue for biopsy. The billing team reports this procedure using CPT code 61510.
Removal of an Oligodendroglioma
Let’s assume a 36-year-old man arrives at a neurology clinic with two primary complaints: doubled vision and severe headaches. The neurologist performs a neurological exam and orders diagnostic tests, including an MRI and CT scan, to determine the underlying cause.
The results confirm the presence of an oligodendroglioma in the patient’s right occipital lobe — one of the lobes at the back of the head responsible for visual perception. The neurosurgeon then performs a craniotomy to remove the tumor.
However, due to a high risk of postoperative swelling, he does not replace the bone flap immediately. The billing team submits a claim for this surgery using CPT code 61510.
Applicable Modifiers for CPT Code 61510
You can use the following modifiers with CPT code 61510 based on the specific circumstances:
Modifier 59
This modifier helps you report codes that are rarely billed together. You can apply modifier 59 to CPT code 61510 if the surgery was distinct and separately identifiable from other procedures performed on the same day. However, you should consider this two-digit code a last resort and only use it when no other modifier can explain the situation.
Modifier 22
What if the procedure was more complicated and detailed than expected? A craniotomy can take anywhere between 4 to 6 hours. If it takes more time and requires more work due to increased complexity, use modifier 22 with CPT code 61510 to communicate this information to payers.
Modifier 52
Append modifier 52 to CPT code 61510 if the surgical procedure performed was less extensive. In simple terms, use this code if you intentionally reduced one or two steps of craniotomy.
Modifier 53
What if a healthcare provider discontinued craniotomy due to high risk? Some types of craniotomies can be life-threatening. So, if you abandoned this surgery after administering anesthesia due to some extenuating circumstances, such as seizures, bleeding, or stroke, you can use modifier 53 to receive partial payment.
Modifier 62
What if the operation requires the skills of more than one professional? Append modifier 62 to CPT code 61510 if two surgeons were involved in the brain tumor removal surgery.
Modifier 80
You can apply modifier 80 to CPT code 61510 if an assistant surgeon is involved in the craniotomy.
Modifier 82
You can use modifier 82 if an assistant surgeon was involved in the procedure due to the unavailability of another resident surgeon.
CPT Code 61510 – Billing & Reimbursement Guidelines
Insurance companies need a single reason to deny your claim. Therefore, don’t give them any opportunity! Follow our billing and reimbursement guidelines for CPT code 61510 to ensure accurate claim submission:
Understand the Purpose of CPT Code 61510
As mentioned earlier, CPT code 61510 reports a craniectomy or craniotomy performed to remove a brain tumor, excluding meningiomas, in the supratentorial region. This procedure has a 90-day global period. Hence, you should not bill routine preoperative, intraoperative, and postoperative services separately.
Apply Correct Modifiers (Depending on the Situation)
Our next tip is to use modifiers to report unusual circumstances. These may include:
- Reduced or discontinued craniotomy procedure
- Increased procedural services
- The involvement of an assistant or co-surgeon
Support Your Procedure with Proper Documentation
You may need to justify the medical necessity of CPT code 61510. Therefore, maintain proper documentation, including a detailed operative report, to avoid claim denials. Record the following details in the patient’s medical records:
- Patient’s symptoms
- Condition
- Diagnostic tests (e.g., MRI or CT scan) and results
- Tumor location (must be in the supratentorial region)
- Tumor type (e.g., astrocytoma, ganglioglioma, dysembryoplastic neuroepithelial tumor, or oligodendroglioma)
- Extent of tumor removal
- Use of specialized tools (e.g., drills, ultrasonic aspirators)
- Any complications
Don’t forget to include even the smallest details, such as doctor’s notes, to strengthen your claim.
Comply with Payer-Specific Requirements
The most important thing is to ensure compliance with payer policies and federal regulations. Therefore, you should review Medicare’s national and local coverage determinations (NCDs and LCDs) before filing any claim.
Additionally, check the coverage guidelines of private insurers. Don’t forget to obtain prior authorization for CPT code 61510 if required.
Conclusion
In conclusion, CPT code 61510 is one of the codes for reporting craniectomy or craniotomy. It covers the removal of a skull portion and excision of a brain tumor in the supratentorial region. In simple terms? The upper part of the brain! There is a different code for tumor excision in the lower part of the brain.
Healthcare providers use CPT code 61510 to document and request compensation for their expertise. However, they often receive claim denials due to inappropriate usage, such as billing for meningiomas removal or incorrect modifiers. Are you also struggling with this or any other neurosurgery code? You can always ask for a professional’s guidance.For example, at MediBillMD, we also cover coding in our neurosurgery billing services. So, sit back and relax! Let an expert help you receive complete payments for craniotomy.
