AHA Coding Clinic® for HCPCS - 2024 Issue 1; Ask the Editor

Insertion of cranial bone fiducials

The patient presented to ambulatory surgery for placement of cranial fiducial markers in preparation for deep brain stimulation (DBS), at a future encounter. After induction of anesthesia and scalp preparation, the first of the four stab incisions was made in the anterior scalp with a #15 blade. A Penfield #4 was used to scrape the periosteum off the cranial surface. An OsteoMed hand power drill was loaded with the 5mm fiducial marker screw, which was then drilled flush to the skull. After verifying the appropriate placement, the incision was closed with sutures. These steps were subsequently repeated for the other three stab incisions. After closure, the four incisions were dressed with bacitracin ointment, Telfa™ and Tegaderm™. While still under sedation, the patient was transported from the operating room to imaging where a stereotactic Stealth computed tomography (CT) was performed. After completion of the CT, the patient was then transferred to recovery in stable condition. Is it appropriate to report CPT code 20660, for the fiducial marker placement? Since the marker placement was the only procedure performed, how should the facility report the procedure? ...

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