# CPT 62165 and 31291



## mkacmar (May 29, 2014)

My ENT surgeon wants to bill 31291 (endoscopic repair of CSF leak, sphenoid region) on the back end of CPT 62165 (modifier 62) neuroendoscopic excision of pituitary tumor, trans-sphenoidal approach) with a neurosurgeon. When I informed him I did not think this was allowed as the repair of the skull base was part of the primary code 62165, he objected stating that since the bone and dura are violated, the brain is exposed and if the area is not closed, meningitis will develop. Additionally, a lumbar drain was placed by the neurosurgeon, and a leak could not be recognized at the time of surgery, and he feels he should be able to bill for 31291. Again, there was no CSF leak at the time of closure and I pointed out CPT 31291 specifically addresses a CSF leak. I also said, if the approach includes removing something for access to the repair, I did not believe billing for the closure of the same area was permitted. He filled the sphenoid sinus with DuraSeal, placed Gelfoam against the DuraSeal for the repair.

Does anyone have more info on this and if billing separately for the repair with CPT 31291 is allowed in this example?


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