January 9, 2014
One of our surgeons recently performed surgery on a patient with Parkinson’s disease. The surgery is described on the op report as follows: 1. Bilateral burr holes for implantation of subthalamic nucleus deep brain stimulation electrodes. 2. Intraoperative electrophysiologic recording and microelectrode recording. We billed 61867, 20660,61868, 95961-26,95962-26. The insurance company is denying payment for 20660, 95961 and 95962 (mapping/stimulation) saying the codes are inclusive. Is there any way we can get this paid?
Actually the procedure you describe is reported using only 61867 and 61868. CPT 20660 (placement of the stereotactic head frame) is included in 61867/61868 as is the mapping/microelectrode recording (95961/95962) and all three of these codes should not have been separately reported. The payor was correct to deny them. We advise adjusting off the charges and not billing them in future cases.