# Coding Burr Holes



## mom2all82 (Feb 26, 2009)

I need some clarification on the proper billing of CPT 61154 - Burr hole(s) with evacuation and/or drainage of hematoma, extradural or subdural.  Based on the description it appears that this one code covers one or more burr holes.  Yet it says for bilateral to use the 50 modifier.  I had a case where there was a burr hole created in the frontal and parietal occipital.  The code was billed twice and Medicare paid.  I have been told that this code should only be billed once.  I am confused.  Any insight into the proper billing of this code is greatly appreciated.  Also does anyone know of any neurosurgery classes out there?


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## RebeccaWoodward* (Feb 26, 2009)

61154 is a unilateral procedure.  If performed bilaterally, you would append modifier 50.  The Neurosurgery Coding Companion describes it as a "mirror image"....performed indentically on the opposite side.  Below is a link for the regions of the brain.

http://en.wikipedia.org/wiki/Occipital_lobe

I highly recommend that you join the Neurosurgery list serve.  These are coders all over the country that specialize in this field.  Classes are hard to find particular to this topic, only.  I have attended some of the AAPC Orthopedic workshops and some of the instructors did have experience in spine and cranial procedures.  I was pleased with the consultant from Karen Zupko and Assoc.  If you don't have the link for the Neurosurgery list serve, PM me and I'll look it up for you. 

Ohh...One more thing.  *Many coders get caught up in the word burr hole(s) in the CPT book.  If the surgeon creates, lets say, 2 holes on the same side, you would only code this once.*


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