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See how these techniques have changed neurosurgery.

Over the years, we have witnessed remarkable innovations in medical treatments for various ailments. From synthetic skin to gene therapy, advancements in medicine have transformed our world over the past couple of decades, because of the diligent research and efforts of health professionals.

Neurosurgery is no exception; surgical advances have given the specialty a high-tech update, employing tactics like beam therapy and obtaining images of the brain via the tiniest of endoscopic cameras.

Read on for information on stereotactic radiosurgery (SRS) and neuroendoscopy, two of the innovative newer procedures for patients suffering from brain and central nervous system problems.

Stereotactic Radiosurgery Utilizes Beam Power

SRS is a highly precise form of radiation therapy that utilizes focused beams to target and destroy tumors or other lesions on the brain or spine while minimizing damage to surrounding healthy tissue. This nonsurgical approach requires no anesthesia or incisions, making it a safer option for high-risk patients in lieu of traditional surgical procedures.

How it works: This advanced procedure effectively destroys tumors by damaging the lining of cancer cells, preventing their reproduction and facilitating tumor shrinkage. SRS can treat various conditions, including brain tumors, trigeminal neuralgia, and brain arteriovenous malformations. Many SRS procedures are completed in a single session, saving patients from an arduous healing process.

Neuroendoscopy Uses Endoscope to Get Images

Neuroendoscopy is a minimally invasive surgical technique that uses a thin, lighted tube with a camera (or endoscope) to access the brain and spine. This minimally invasive option allows surgeons to reach deep-seated brain lesions and structures that are challenging to access with traditional surgical methods.

While both stereotactic radiosurgery and neuroendoscopy are used in neurosurgery, they serve different purposes. SRS is a form of radiation therapy, while neuroendoscopy is a surgical technique. 

Why choose neuroendoscopy? Neuroendoscopy is particularly beneficial for treating cystic diseases and accessing areas around the brainstem and pituitary gland. It can be used for a variety of procedures, including tumor removal, aneurysm repair, and cyst drainage. Additionally, neuroendoscopy offers several advantages, including reduced trauma, shorter hospital stays, and faster recovery times.

Know Relationship Between SRS and Neuroendoscopy

SRS and neuroendoscopy can be used together in certain cases. For instance, neuroendoscopy may be employed to access a tumor that is subsequently treated with SRS. 

SRS can also serve as a follow-up treatment after neuroendoscopy procedures to further reduce tumor size or prevent recurrence.

While neuroendoscopy is the primary treatment for colloid cysts, SRS might be considered as an alternative or adjunct treatment in some situations, as noted by the  

Use These Codes for SRS

SRS coding typically falls under CPT^庐 codes 61796 (Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 simple cranial lesion) through +61799 (Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional cranial lesion, complex (List separately in addition to code for primary procedure)) for cranial procedures. Simple lesions are generally defined as being less than 3.5 cm in maximum dimension, while complex lesions are larger or require more intricate planning/delivery.

Additional codes like 77432 (Stereotactic radiation treatment management of cranial lesion(s) (complete course of treatment consisting of 1 session)) and 77435 (Stereotactic body radiation therapy, treatment management, per treatment course, to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions) may be used by radiation oncologists who are fully involved in SRS management. 

1 more thing: Headframe placement should also be captured when applicable. Code +61800 (Application of stereotactic headframe for stereotactic radiosurgery (List separately in addition to code for primary procedure)) is used in conjunction with 61796 and 61798. 

Check for 2 Surgeons When Coding Neuroendoscopy

When coding neurosurgical endoscope procedures, CPT^庐 code 62161 (Neuroendoscopy, intracranial; with dissection of adhesions, fenestration of septum pellucidum or intraventricular cysts (including placement, replacement, or removal of ventricular catheter)) describes a neuroendoscopy procedure that involves intracranial access and dissection of adhesions or cysts. For the endoscopic endonasal approach to a skull base tumor, code 62165 (鈥� with excision of pituitary tumor, transnasal or trans-sphenoidal approach) is used, according to a study published by the . If a co-surgeon participates in the procedure, modifier 62 (Two surgeons) should be appended to 62165.

The other codes for neuroendoscopy are 62162 (鈥� with fenestration or excision of colloid cyst, including placement of external ventricular catheter for drainage) and 62164 (鈥� with excision of brain tumor, including placement of external ventricular catheter for drainage).

Make note: Surgical endoscopy services always include diagnostic endoscopy. These should never be unbundled when performed concurrently.

Remember: If there is no specific CPT^庐 code for the neuroendoscopy procedure conducted, an unlisted procedure code should be used instead of the 鈥渕ost specific鈥� CPT^庐 code you can find. It is essential to bill the most accurate code for proper billing; sometimes, this means using unlisted codes.

Both neuroendoscopy and stereotactic radiosurgery procedures are key areas within the neurosurgical specialty. Enhancing your knowledge of these procedures can quickly elevate your expertise from beginner to expert.

Jessica Sullivan, CPC, COBGC, COSC, Consultant, Pinnacle Enterprise Consulting Services (PERCS)