# Brain Biopsy via craniotomy



## KLS515

Brain biopsy with craniotomy/bone flap... The burr drill was used, but then a flap was created, and a 1 cm size leptomeningeal and brain cortex was resected with scapel. Bone flap repositioned.  More work than a burr hole biopsy.  I can't seem to locate a CPT code.  Any suggestions?


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## RebeccaWoodward*

I have a note in my CPT that the AANS recommends 61304/61305 for Crani bx associated with a crani...  

I also have this...

"Code 61250 is used to report Burr holes placed supratentorially for exploratory purposes. Exploratory burr holes may be placed in selected multi-trauma patients with severe head injury in the following sequence: temporal, frontal, parietal (according to the frequency of occurrence of intracranial extra axial hematomas). The side for initial exploration will be the right in all cases except where lateralizing signs (such as pupillary asymmetry or hemiparesis) are present.

Code 61156 is used to report aspiration of an intracerebral cyst or hematoma using trephination or a Burr hole. In this procedure, a small catheter is placed through the burr holes in order to drain a cyst or abscess. A number of different types of cysts may be found within the brain, including colloid cysts, subarachnoid and arachnoid cysts. Additionally, a number of different types of abscesses may be present, including parasitic, bacterial and other types of infections.

Code 61140 describes a biopsy obtained by trephination or a Burr hole. With a biopsy, a small piece of the brain tumor is removed and sent for pathological examination.

The implantation of devices such as catheters, reservoirs and pressure recording devices implanted using a burr hole is reported using code 61210. It also may be used to report EEG electrodes placed using a similar approach.

As evidenced above, some trephination/Burr hole procedures will differentiate between work that is done above the tentorium (supratentorial) versus that done below the tentorium (infratentorial). The tentorium is the process of dura mater which exists between the cerebrum and cerebellum supporting the occipital lobes.

Remember to use these codes only if a more extensive craniotomy is NOT performed at the same surgical session. CPT guidance states, "If burr hole(s) or trephine are followed by craniotomy at same operative session, use 61304-61321; do not use 61250 or 61253." Carefully review the operative report to make sure that a more extensive approach is not subsequently used to treat the lesion.

*Whenever you encounter the term Burr hole while reading the operative report, distinguish between a Burr hole used as the primary surgical approach versus those used in conjunction with a craniotomy. In a procedure commonly described as a "bone flap craniotomy," several Burr holes are used to help develop a bone flap. If this is the case, the surgical approach is not a Burr hole, but rather a craniotomy/craniectomy and the correct craniotomy/craniectomy code should be used.*

Many of these codes include the parenthetical "(s)" with the term describing a Burr hole [i.e., "Burr hole(s)"]. The presence of the "(s)" indicates that these codes may be used only once regardless of the number of Burr holes necessary to perform the procedure at the specific location of the brain. These codes should be used once regardless of the laterality or number of Burr holes involved at a specific location or for a specific lesion.

When a Burr hole or holes is medically necessary to perform procedures at a different anatomic location of the brain, a separate code identifying the Burr hole and specific procedures performed may be necessary. This often requires the use of modifier in order to identify that a separate and distinct location was involved."

Does this help?


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## KLS515

I was looking at 61304, but being that the procedure was for a biopsy and the code states exploratory, I wasn't sure.  There was no therapeutic procedure performed, the biopsy is diagnostic, so I am leaning towards this exploratory code. 

I know for sure I do not want to use the burr hole biopsy code for this.
Thank you for your help ~


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## cpear97

*Endoscopic Brain biopsy*

Needing to know what code you would use for a stereotatic transventricular endoscopic biopsy.  Would you still use 61751?

Cheryl


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