How To Use CPT Code 61796

CPT 61796 describes the procedure of stereotactic radiosurgery for a single, simple cranial lesion. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 61796?

CPT 61796 can be used to describe the procedure of stereotactic radiosurgery for a single, simple cranial lesion. This code is used when the provider uses externally generated ionized radiation to destroy a targeted area in the brain. The targeted lesion is considered simple, with a maximum dimension typically less than 3.5 cm.

2. Official Description

The official description of CPT code 61796 is: ‘Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 simple cranial lesion.’ It is important to note that this code should not be reported more than once per course of treatment and should not be reported in conjunction with CPT code 61798.

3. Procedure

1. The provider positions the patient appropriately and may place fiducial markers or a stereotactic head frame on the patient’s scalp.
2. The provider works with radiology to obtain optimal images of the simple cranial lesion using computed tomography (CT) or magnetic resonance imaging (MRI) scans.
3. Once the target area is identified, the provider uses a computer system to precisely pinpoint the targeted site.
4. A robotic arm controlled by the computer is used to focus radiation on the target area and destroy the simple lesion.

4. Qualifying circumstances

CPT 61796 is performed on patients with a single, simple cranial lesion. This procedure is used to treat conditions such as arteriovenous malformations, schwannomas, and other simple lesions. It is important to note that complex lesions, such as those near the optic nerve or brainstem, should be coded differently.

5. When to use CPT code 61796

CPT code 61796 should be used when the provider performs stereotactic radiosurgery for a single, simple cranial lesion. It is important to note that this code should not be used for multiple treatments on the same lesion, as it includes the course of treatment. Separate lesions should be reported with add-on code +61797.

6. Documentation requirements

To support a claim for CPT 61796, the provider must document the following information:

• Details of the simple cranial lesion being treated
• Imaging markers or stereotactic head frame used
• CT or MRI scans imported into the computer system
• Coordinates and dosage plan for targeting and dose planning
• Start and end time of the procedure
• Details of the robotic arm and computer system used

7. Billing guidelines

When billing for CPT 61796, ensure that the procedure is performed for a single, simple cranial lesion. It is important to note that this code should not be reported with other codes unless specified in the documentation. Separate procedures for the stereotactic head frame should be reported with code 61800.

8. Historical information

CPT 61796 was added to the Current Procedural Terminology system on January 1, 2009. There have been no updates to the code since its addition.

9. Examples

1. A provider performs stereotactic radiosurgery for a simple cranial lesion measuring 2 cm in diameter.
2. A patient with an arteriovenous malformation undergoes stereotactic radiosurgery for a single cranial lesion.
3. A provider uses a linear accelerator to perform stereotactic radiosurgery for a simple cranial lesion.
4. A schwannoma in the brain is treated with stereotactic radiosurgery using a particle beam.
5. A patient with a simple cranial lesion undergoes stereotactic radiosurgery using gamma ray technology.
6. A provider performs stereotactic radiosurgery for a single, simple cranial lesion measuring 3 cm in diameter.
7. A patient with a simple cranial lesion near the optic nerve undergoes stereotactic radiosurgery.
8. A provider uses a stereotactic head frame to perform stereotactic radiosurgery for a single cranial lesion.
9. A schwannoma in the brain is treated with stereotactic radiosurgery using a linear accelerator.
10. A patient with a simple cranial lesion undergoes stereotactic radiosurgery using particle beam technology.