Coding

Spinal Navigation

Paul Saiz, MD

3 Crosses Orthopaedic Spine

Las Cruces, NM

With the increased use of navigation, many questions arise regarding when it is appropriate to code for use of the various stereotactic navigation systems available. This article will focus on spinal navigation and give a brief history and description of the code.

History

Prior to 2011, CPT code 61795 was reported as an add-on code when medically necessary, for all stereotactic computer-assisted volumetric (navigational) procedures, whether intracranial, extracranial, or spinal. Starting in October 2008, 61795 Stereotactic computer-assisted volumetric (navigational) procedure, intracranial, extracranial, or spinal was revisited secondary to potential misvaluation by the RUC. In 2011, this was divided into three codes 61781, 61782, 61783.*

  • +61781 refers to Stereotactic computer assisted (navigational) procedure; cranial, intradural.
  • +61782 describes Stereotactic computer assisted (navigational) procedure; cranial, extradural.
  • +61783 is used for Stereotactic computer assisted (navigational) procedures; spinal.

*These codes are add-on codes (“+”) and must follow the primary procedure code. They can be used only once per operative session.

All CPT codes are broken down into preservice work, intraservice work, postservice work, and practice expense. In addition, each code has a vignette, describing the procedure, and includes a variety of details to capture the typical work involved for a typical patient undergoing that procedure. Additionally, elements of time to perform the procedure, and the intensity involved in providing it, also contribute to the weight and value of each code.

61783 Stereotactic Computer Assisted (Navigational) Procedures; Spinal

For code 61783, there is no postservice work or practice expense. The vignette associated with code 61783 involves C1-2 transarticular fixation. This scenario highlights the complexity of the primary procedure for which add-on navigation is appropriate. The spinal navigation code also has a significant component of preservice work, estimated at 15 minutes. This includes having a discussion with the patient regarding the risks and benefits of using the technology. What structures will the navigation allow you, as the surgeon, to avoid. The work also includes uploading the images to the navigation, turning on and positioning the machine, and lastly verifying the position of the patient will allow the navigational markers to be seen by the device.

During surgery, the navigational markers must be placed by the physician, the markers must be registered, and the accuracy must be assessed between the markers and the anatomic landmarks (osseous). During placement of hardware, the accuracy of the information must be continuously evaluated for each implant, and finally the trackers must be removed.

Coding and Billing

To code for 61783, the documentation should include the physician work of image-based planning, description of the image acquisition, attachment of a reference frame, registration and review of the image data sets, and verification of the accuracy.1,2 This is in addition to using the data provided to estimate starting points and trajectories, deciding on screw diameter and lengths, and avoidance of vital structures.

Spinal navigation is eligible for billing when its use is medically necessary and properly documented to reflect the planning and intraoperative application for surgical safety. However, it should not be billed if utilized solely for post-implant placement verification.

To summarize:

  • 61783 is made up of preservice and intraservice work.
  • The purpose of spinal navigation, described by code 61783, “is to help identify anatomy and, more specifically, to aid with instrumentation placement or other complex procedures.”1,2
  • To apply 61783 appropriately, the indication must be detailed, and the surgeon needs to be involved with all the described work associated with navigation system use, and document this involvement in their operative note.
  • Code 61783 is not for stereotactic radiosurgery, and should not be combined with codes 63620 and 63621.1,2
  • In addition, code 61783 cannot be used with decompression codes 63001-63048.1
  • When intraoperative imaging is used for imaging alone, it does not qualify for 61783. The work component of the code is the preparation for and intraoperative use of navigation, not the imaging.

References

  1. Stereotactic Computer-Assisted (Navigational) Procedures. CPT Assistant. July 2011, page 12.
  2. Coding Correction: Reporting Stereotactic Computer-Assisted (Navigational) Procedures. CPT Assistant. Jan 2014, page 8.

Author Disclosure

P Saiz: Other: TurningPoint Healthcare Solutions (D); Stock Ownership: Doctorpedia (None, <1%).

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