Forum - Questions & Answers

Apr 29th, 2015 - LBAROGIANIS 250 

CPT® 61510 and CPT® 61304

I received a denial stating that 61304 is incidental to 61510. I say yes, but my co-worker states no. Basically, there was biopsy done and a lesion taken out as well. Anyone have any thoughts?
Thank you!

Apr 29th, 2015 -

re: CPT® 61510 AND CPT® 61304

per the CPT® book 61304 is listed as an exploratory crainiectomy and 61510 is also liasted as an crainiectomy for excision of brain tumor. As with diagnostic procedures if you do a surgical procedure doing the diagnostic, you cannot bill for the diagnostic portion. I would think that the same rules apply for exploratory as you are already doing the exploratory which lead to the surgical of removing the tumor. In my opinion you are double dipping.

Apr 29th, 2015 - petunia 195 

re: CPT® 61510 AND CPT® 61304

Per CCI 61510 and 61304 are bundled codes. A modifier is allowed if the documentation supports. In my opinion I would not bill both codes.

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