How To Use CPT Code 61799

CPT 61799 describes the procedure for stereotactic radiosurgery to destroy each additional cranial lesion in the brain after the destruction of a first complex cranial lesion. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 61799?

CPT 61799 can be used to describe the procedure for stereotactic radiosurgery to destroy each additional cranial lesion in the brain. This code is used when a provider uses externally generated ionized radiation to target and destroy complex lesions in the brain that are larger than 3.5 cm.

2. Official Description

The official description of CPT code 61799 is: ‘Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional cranial lesion, complex (List separately in addition to code for primary procedure).’ This code should be used in conjunction with code 61798 for the primary procedure. It is important to note that for each course of treatment, codes 61797 and 61799 may be reported no more than once per lesion. Additionally, the combination of codes 61797 and 61799 should not be reported more than 4 times for the entire course of treatment, regardless of the number of lesions treated.

3. Procedure

1. After the destruction of an initial complex cranial lesion, the provider prepares the patient for additional cranial lesion destruction at the same encounter.
2. The provider uses the stereotactic method to identify the target area, importing previously taken CT or MRI images into a computer system to provide three-dimensional images of the brain.
3. Using scalp markers, imaging markers, and/or an external stereotactic head frame, the provider accurately pinpoints the targeted site.
4. A robotic arm controlled by a computer is used to focus radiation on the target area and destroy the complex lesion.
5. For each isocenter that needs to be treated, the provider sets the stereotactic coordinates calculated in the computer.

4. Qualifying circumstances

Patients eligible for CPT 61799 are those who have complex cranial lesions in the brain that are larger than 3.5 cm. Complex lesions include those within 5 mm of the optic nerve, chasm, or tract, as well as brainstem lesions, schwannomas, arteriovenous malformations, glomus tumors, pineal region tumors, cavernous sinus tumors, and pituitary, parasellar, and petroclival tumors. The provider must use stereotactic radiosurgery, which includes computer planning, dose planning, targeting coordinates, patient positioning, and/or patient blocking to shield areas that are not to be irradiated.

5. When to use CPT code 61799

CPT code 61799 should be used when a provider is performing stereotactic radiosurgery to destroy each additional cranial lesion in the brain after the destruction of a first complex cranial lesion. It should not be used for the primary procedure, as that is described by code 61798.

6. Documentation requirements

To support a claim for CPT 61799, the provider must document the following information:

• Identification of the complex cranial lesion and the need for additional lesion destruction
• Use of stereotactic radiosurgery and the specific technique employed
• Date and duration of the procedure
• Number of additional cranial lesions treated
• Any complications or adverse events that occurred during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 61799, ensure that the provider is performing stereotactic radiosurgery to destroy each additional cranial lesion in the brain. It is important to note that code 61799 should not be reported with multiple units for multiple treatments on the same lesion, as the code includes the course of treatment, even if performed over several sessions. For treatment of separate lesions, report one unit of add-on code 61799 for each separate lesion treated, up to four times.

8. Historical information

CPT 61799 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 performing stereotactic radiosurgery to destroy an additional complex cranial lesion in the brain after the destruction of a first complex cranial lesion.
2. A patient with multiple complex cranial lesions receiving stereotactic radiosurgery to destroy each additional lesion in the brain.
3. A provider using particle beam stereotactic radiosurgery to target and destroy an additional complex cranial lesion in the brain.
4. A patient with a large complex cranial lesion undergoing stereotactic radiosurgery to destroy each additional lesion in the brain.
5. A provider performing stereotactic radiosurgery to destroy an additional complex cranial lesion in the brain, using a linear accelerator.
6. A patient with multiple complex cranial lesions receiving stereotactic radiosurgery to destroy each additional lesion in the brain, using gamma ray therapy.
7. A provider using stereotactic radiosurgery to destroy an additional complex cranial lesion in the brain, after the destruction of a first complex cranial lesion, using a linear accelerator.
8. A patient with a large complex cranial lesion undergoing stereotactic radiosurgery to destroy each additional lesion in the brain, using particle beam therapy.
9. A provider performing stereotactic radiosurgery to destroy an additional complex cranial lesion in the brain, using gamma ray therapy.