Contemporary Use of Common Procedural Terminology (CPT) Codes for Surgical Management of Cerebellopontine Angle Tumors

Objectives - Cerebellopontine angle (CPA) tumors, including vestibular schwannomas (VS), often require microsurgical resection. These are typically surgical procedures performed by co-surgeons, and some controversy and confusion exists regarding use of common procedural terminology (CPT) codes for billing, given the American Medical Association (AMA) describes two distinct coding sets for such cases. This investigation endeavored to: 1) Comprehensively review all surgical coding options; 2) Instruct on application; and 3) Explore contemporary coding trends among surgeons. Design - A multi-disciplinary task force (Otologist/Neurotologists and Neurosurgeons) performed direct correspondence with various surgical societies, private consultancies, and the AMA. Survey instruments were distributed to active surgeons. Setting – Investigational period: 2022-2025. Survey instruments distributed at the 2023 American Neurotology Society (ANS) Fall Meeting. Participants –ANS, American Academy of Otolaryngology (AAO-HNSF), and the North American Skull Base Society (NASBS) representatives. Outcomes Measures – Usage rate for CPT code sets (percentage of responders). Results – Two CPT coding systems are currently accepted for surgical management of CPA tumors. The Traditional/Legacy codes (Indicator-2) allow use of co-surgery modifiers (-62). The newer Approach/Resection Codes (Skull-Base codes; Indicator-1) restrict modifier use. The history, application, and controversies surrounding the codes are detailed herein. 40% of surgeons reported use of the Traditional Codes, while 45-49% use the Skull-Base Codes. Response rate was 31% of the active ANS membership in 2023. Conclusions – The AMA recognizes two CPT code sets for surgical management of CPA tumors. Both are appropriate, if properly applied. Contemporary surgeons likely utilize the sets in equal proportions.