CPT for ENT: Stereotactic Computer Assisted Navigation
Q: What is stereotactic computer assisted navigation and how can I bill for it (from January 1, 2011) when I perform FESS?
A: Stereotactic computer assisted navigation (SCAN), also known as image guidance, is typically used by otolaryngologist - head and neck surgeons when performing functional endoscopic sinus surgery (FESS) and skull base approaches. Image guidance provides surgeons with a more detailed view of intra-cranial and extra-cranial structures such as: areas near the eyes, brain, major veins, arteries and nerves that they may encounter during FESS. Image guidance is commonly used when performing revision FESS procedures where significant scarring may be present and usual anatomical landmarks are no longer in place or on complex sinus cases where the anatomy may be distorted. Complications are better avoided when the surgeon has improved ability to judge the location of instruments during sinus surgery. To find out more indications for image guidance, view our position statement Intra-Operative Use of Computer Aided Surgery
You can bill a SCAN procedure if you can show its medical necessity in your operative notes. The decision to utilize image guidance is the surgeons but obtaining reimbursement is more likely to occur when medical necessity is clearly documented. Effective from January 1, 2011 the appropriate CPT codes for billing image guided FESS are +61781 stereotactic computer assisted (navigational) procedure; cranial, intradural (list separately in addition to code for primary procedure) or +61782 cranial, extradural (list separately in addition to code for primary procedure in addition to the appropriate FESS code. The final physician work Relative Value Units (RVUs) for 61781 and 61782 are 3.75 and 3.18 respectively. Generally, otolaryngologist head and neck surgeons would utilize the second code, +61782. CPT code +61795-Stereotactic computer assisted volumetric (navigational) procedure, intracranial, extracranial, or spinal (List separately in addition to code for primary procedure), which was previously used to report this service has been deleted because the CPT Editorial Panel split it into three separate codes (61781, 61782 and 61783) to differentiate distinct anatomic regions.
After CMS releases the final correct coding initiative (CCI) edits pertaining to the SCAN procedure we will post them on our website and update this article. There may be local coverage determinations (LCDs) which restrict the circumstances for which you can obtain reimbursement for the SCAN procedure. If you have difficulty with reimbursement exhaust the carriers appeals process. If you are unsuccessful at overturning this decision contact the Health Policy team.
Revised December 2010
Reviewed April 2008
Reviewed June 2009
Approved January 2011
Important Disclaimer Notice (Updated 8/7/14)
CPT for ENT articles are a collaborative effort between the Academy’s team of CPT Advisors, members of the Physician Payment Policy (3P) workgroup, and health policy staff. Articles are developed to address common coding questions received by the health policy team, as well as to clarify coding changes and correct coding principles for frequently reported ENT procedures. These articles are not intended as legal, medical, or business advice and are not a guarantee of reimbursement. The information is also not meant to serve as the definitive or sole authority on billing and coding issues. The applicability of AAO-HNS billing and coding guidance for a particular procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. You should consult with your own advisors as well as Medicare or private carriers in making any decisions about how to bill and code particular services or procedures.