How To Use CPT Code 61798

CPT 61798 describes the procedure for stereotactic radiosurgery on a complex cranial lesion using particle beam, gamma ray, or linear accelerator. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 61798?

CPT 61798 can be used to describe the procedure for stereotactic radiosurgery on a complex cranial lesion. This code is used when the provider uses externally generated ionized radiation, such as particle beam, gamma ray, or linear accelerator, to destroy a single complex cranial lesion in the target area of the brain. The targeted lesion is typically larger than 3.5 cm in size.

2. Official Description

The official description of CPT code 61798 is: ‘Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 complex cranial lesion. Do not report 61798 more than once per course of treatment. Do not report 61798 in conjunction with 61796.’

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. Radiology works with the provider to obtain computed tomography (CT) or magnetic resonance imaging (MRI) scans of the target area, which are imported into a computer system to create three-dimensional images of the brain.
3. The provider collaborates with radiation oncology to determine the optimal dosage of ionizing radiation for the patient, using the computer system to create dose planning programs.
4. The provider tests the coordinates and dosage plan to ensure accuracy.
5. Using the stereotactic method, the provider accurately pinpoints the targeted site using the CT or MRI scans, scalp markers, and/or the stereotactic head frame.
6. A robotic arm controlled by a computer focuses radiation on the target area to destroy the complex cranial lesion.

4. Qualifying circumstances

Patients eligible for CPT 61798 are those with a complex cranial lesion that requires stereotactic radiosurgery. Complex lesions are typically larger than 3.5 cm and may include arteriovenous malformations, schwannomas, glomus tumors, pineal region tumors, cavernous sinus tumors, pituitary tumors, parasellar tumors, petroclival tumors, and brainstem lesions. The procedure must be performed by a provider using particle beam, gamma ray, or linear accelerator.

5. When to use CPT code 61798

CPT code 61798 should be used when a provider performs stereotactic radiosurgery on a complex cranial lesion using particle beam, gamma ray, or linear accelerator. This code should not be reported more than once per course of treatment and should not be reported in conjunction with CPT code 61796.

6. Documentation requirements

To support a claim for CPT 61798, the provider must document the following information:

• Diagnosis of the complex cranial lesion
• Details of the stereotactic radiosurgery procedure
• Start and end time of the procedure
• Imaging used for targeting and dose planning
• Coordinates and dosage plan tested for accuracy
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 61798, ensure that the procedure is performed on a complex cranial lesion using particle beam, gamma ray, or linear accelerator. Do not report CPT 61798 more than once per course of treatment. Do not report CPT 61798 in conjunction with CPT 61796.

8. Historical information

CPT 61798 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 on a complex cranial lesion using a linear accelerator.
2. Using a gamma ray, a provider performs stereotactic radiosurgery on a complex cranial lesion.
3. A particle beam is used by a provider to perform stereotactic radiosurgery on a complex cranial lesion.
4. A provider performs stereotactic radiosurgery on a complex cranial lesion, which is a glomus tumor.
5. Using a linear accelerator, a provider performs stereotactic radiosurgery on a complex cranial lesion, which is a pineal region tumor.
6. A provider performs stereotactic radiosurgery on a complex cranial lesion, which is an arteriovenous malformation.
7. Using a gamma ray, a provider performs stereotactic radiosurgery on a complex cranial lesion, which is a cavernous sinus tumor.
8. A particle beam is used by a provider to perform stereotactic radiosurgery on a complex cranial lesion, which is a pituitary tumor.
9. A provider performs stereotactic radiosurgery on a complex cranial lesion, which is a parasellar tumor.
10. Using a linear accelerator, a provider performs stereotactic radiosurgery on a complex cranial lesion, which is a brainstem lesion.