# Suboccipital Craniectomy



## toiwalker (Apr 17, 2013)

Can some one please hepl me with this? I coded 61315 and 88307. Is duraplasty included in the code?

PROCEDURE:
1.  Suboccipital craniectomy.
2.  Evacuation of cerebellar hematoma.
3.  Left cerebellar hemispherectomy.
4.  Duraplasty.

OPERATIVE  REPORT

PREOPERATIVE  DIAGNOSIS:
Left cerebellar intraparenchymal  hematoma with herniation.

POSTOPERATIVE  DIAGNOSIS:
Left cerebellar intraparenchymal  hematoma with herniation.



DETAILS OF THE PROCEDURE:
Informed consent for the procedure was obtained from the patient's husband by Dr. Saphier.  Relevant risks and complications were discussed include the risk of infection, stroke, scar, need for reoperation, neurological deficits, meningitis, cerebrospinal fluid leak, coma, paralysis, death.  The patient taken to the operating room, intubated in a critical condition.  Prior to commencement  of the procedure, timeout was performed to verify the site and side of procedure as well as the patient's identification.  General endotracheal tube anesthesia was administered by the 
anesthesiology attending who also monitored the patient throughout the entire  case.   The patient  was placed  in 3-point  pin fixation in the Mayfield  head holder  and subsequently turned  to the prone  position  on holsters  with the head flexed.   Care was taken to ensure  adequate  padding  of all pressure  points.   The patient's  suboccipital region  and posterior  neck and
chest were shaved,  prepped  and draped  in standard and sterile  manner.   Lidocaine 1% was infused  in the region  of planned incision.   The #10 scalpel blade was utilized  to create  a linear incision and self-retaining retractors were placed within the field.   Hemostasis was obtained with a combination of bipolar  and Bovie  cautery.   Incision  was continued through  the dorsal  midline fascial  raphae  and an avascular  plane was created  in the median  raphae.   Subperiosteal dissection was performed in the suboccipital region  and both Cl and C2 were identified.  Subperiosteal plane was created  from  C1.  Copious  irrigation was applied.   After the suboccipital region  was completely exposed  and the margins  of the foramen magnum  were identified, the M2 drill bit and Stryker  drill were utilized  to create a suboccipital craniectomy. Combination ofLeksell and Kerrison rongeurs were utilized  to complete  the craniectomy, and the foramen magnum  was subsequently removed.  After completion of suboccipital craniectomy, a #15 blade was utilized  was used to create durotomy  in tlte left cerebellar dura.  Immediately upon creation  of durotomy,  herniation of the cerebellum was encountered.  Bipolar  cautery was utilized  to create a corticotomy, and immediately upon corticotomy, a large acute hematoma was expressed.  After adequate  evacuation of the hematoma, a left cerebellar hemispherectomy was performed. Specimen of the hematoma was sent for patltological analysis.   After the cerebellar hemispherectomy and evacuation of the entire hematoma, the cerebellum was noted to be significantly more relaxed.   Copious  irrigation was applied  and hemostasis was obtained.  Surgicel  was placed  within the surgical  bed.   Next, a piece of Duragen  was laid  	over the corticotomy and DuraSeal was applied.   Next, the incision  was subsequently approximated in layers  utilizing  0 Vicryl suture for the deep layers  and 	3-0 Vicryl  suture for the subcutaneous plane.   Staples  were used for skin approximation.  The incision  was thoroughly  washed  and dried and a sterile  dressing  was applied.   The patient  was subsequently returned  to the supine  position  and the Mayfield  head holder  was removed.  Tbe patient  was subsequently transferred to the neurosurgical intensive  care unit, intubated, in critical  condition.


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## taparker (Apr 19, 2013)

Intraparenchymal hematoma...I swear this is the bane of my existence. There isn't a code that really covers this. My docs say that 61322/61323 are what they're doing based on the procedure description in my coding companion, but of course, the code says it excludes these types of hematomas. So I'm curious to see other opinions on it.

Wouldn't you want to code the hemispherectomy also? I would think this would carry a higher charge since it carries more facility RVUs.  I don't see any CCI edits in my coding companion or encoder for coding the duraplasty with 61315 or the code I came up with for the hemispherectomy.


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