Imagine you filed a claim for a complex brain tumor removal procedure. But a few days later, your claim is denied. The reason? Wrong use of CPT code 61510. Looking back at the claim and rejection report, you still have no idea what went wrong. In this situation, your practice or hospital will lose a lot of money.
This scenario plays out in medical billing departments across the country every day. CPT code 61510 is among the most challenging neurosurgical codes to bill, yet it also represents a critical care procedure. So, it is essential to bill it correctly.
That’s why our team of experts at NeuraBill has compiled this guide. We will discuss this code’s correct usage, applicable modifiers, and reimbursement guidelines. So, let’s start.
CPT Code 61510 Description
The official description of CPT code 61510 reads: “Craniectomy, trephination, or bone flap craniotomy” performed for the excision of a brain tumor in the supratentorial region, with the specific exclusion of meningiomas.
CPT code 61510 is in the Surgery/Nervous System section of the CPT manual, within the Skull, Meninges, and Brain subsection, under Cranialectomy or Cranial Osteotomy procedures.
During the procedure, a neurosurgeon removes the bone from the skull to access and excise a tumor located in the upper brain area (above the tentorium cerebelli), with an important exception: the tumor cannot be a meningioma. Here is a step-by-step breakdown of the entire procedure billed under CPT code 61510:
- The patient is positioned appropriately and given general anesthesia.
- The surgeon makes an incision in the scalp and retracts the soft tissues.
- A portion of the skull is removed temporarily using specialized surgical tools.
- The dura mater (the outer protective covering of the brain) is incised to expose the brain tissue.
- The tumor is identified, excised, and removed.
- After tumor removal, the dura is closed, the bone flap is replaced, and the scalp is sutured.
Appropriate Use Cases for CPT Code 61510
The key to proper code selection is understanding when CPT code 61510 applies and, perhaps more importantly, when it doesn’t. To give you a better understanding of the usage, let’s look at some scenarios where it can be used and some situations where it is misreported.
Appropriate Scenarios
Primary Brain Tumors
Code 61510 is commonly used for the surgical removal of primary brain tumors located in the cerebral hemispheres, including but not limited to:
- Gliomas: Including astrocytomas, oligodendrogliomas, and glioblastomas, which originate from glial cells.
- Ependymomas: Tumors that arise from the ependymal cells that line the ventricles.
- Central neurocytomas: Rare benign tumors usually found in the lateral ventricles near the foramen of Monro.
- Choroid plexus tumors: Rare tumors that develop from choroid plexus tissue in the ventricles.
Metastatic Brain Tumors
CPT code 61510 can be used for the removal of metastatic tumors in the brain from primary cancers elsewhere in the body, such as:
- Metastases from lung cancer
- Metastases from breast cancer
- Metastases from melanoma
- Metastases from renal cell carcinoma
- Metastases from colorectal cancer
Supratentorial Brain Cysts
While some cystic lesions of the brain have their own specific CPT code (61516 for excision or fenestration of cyst), certain cystic tumors are coded using 61510, including:
- Cystic astrocytomas
- Hemangioblastomas with cystic components
Important Exclusions
Please note that some closely related medical procedures are billed using different CPT codes and must not be confused with CPT code 61510. Some of these procedures include:
- Excision of meningiomas (61512)
- Excision of brain abscess (61514)
- Excision or fenestration of cyst (61516)
- Excision of infratentorial or posterior fossa tumors (61518-61521)
Modifiers to Append with CPT Code 61510
Modifiers tell the rest of the story that the base code alone cannot convey. The following modifiers may be appended with CPT code 61510, depending on the circumstances:
| Modifier | Description | When to Use with 61510 |
|---|---|---|
| 22 | Increased Procedural Services | When the complexity significantly exceeds the typical, e.g., large/vascular tumors, adhesions, or distorted anatomy. |
| 52 | Reduced Services | When only a portion of the procedure is performed, e.g., partial tumor removal due to constraints. |
| 53 | Discontinued Procedure | When the surgery is terminated due to patient safety risks or extenuating circumstances. |
| 59 | Distinct Procedural Service | When separate, distinct procedures that would otherwise be bundled are performed on the same day. |
| 62 | Two Surgeons | When two surgeons (e.g., a neurosurgeon and another specialist) perform distinct parts together. |
| 80 | Assistant Surgeon | When an assistant surgeon is required for the entire procedure. |
| 82 | Assistant Surgeon (no resident) | In teaching hospitals, when a qualified resident is unavailable and an assistant is needed. |
Reimbursement Guidelines for CPT Code 61510
To correctly file a claim with CPT code 61510, you must be attentive and follow the payer guidelines.
Documentation Requirements
Proper documentation is essential to justify the medical necessity of the procedure. It makes your case stronger and reduces the chance of denials. For CPT code 61510, the documentation should include:
- Detailed preoperative diagnosis with supporting evidence (imaging studies, neurological symptoms)
- Medical necessity justification for the surgical intervention
- Operative report specifying:
- Approach and technique used
- Tumor location, size, and characteristics
- Extent of tumor removal
- Any complications encountered and how they were managed
- Estimated blood loss
- Duration of the procedure
- Pathology report confirming the tumor type
- Postoperative care plan
Bundled Services
Several services are considered integral to 61510 and should not be billed separately, including:
- Routine anesthesia
- Standard positioning and approach
- Closure techniques, including simple dural repair
- Routine hemostasis
However, certain services may be reported separately with adequate documentation. For example:
- Use of an operating microscope for microdissection
- Computer-assisted navigation
- Implantation of chemotherapy agents
- Complex wound closure or reconstruction
Final Thoughts on CPT Code 61510
CPT code 61510 is a complex code to bill. It requires a good understanding of the medical procedure, documentation, and payer guidelines. You can successfully file a claim by implementing the practical strategies outlined in this blog.
If you are facing constant claim denials and want to improve your reimbursement, contact our billing experts for the best neurosurgery billing services.
