Neurosurgery Coding Alert

Check if EEG was obtained when excising epileptogenic foci.

Here are correct answers to the coding quiz.

Answer 1: The correct answer is option a, 61533.

You would report 61533 (Craniotomy with elevation of bone flap; for subdural implantation of an electrode array, for long-term seizure monitoring) when the surgeons enters the cranium to place the electrodes.

If the surgeon only removes the electrodes during the craniotomy, report 61535 (Craniotomy with elevation of bone flap; for removal of epidural or subdural electrode array, without excision of cerebral tissue [separate procedure]).  "Remember that if this is performed by the same surgeon during the 90 day global period of the initial placement, append modifier 58 as the removal is planned as a future stage," says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.

Answer 2: The correct answer is b, 61760.

For implantation of electrodes using a stereotactic method, you submit code 61760 (Stereotactic implantation plantation of depth electrodes into the cerebrum for long-term seizure monitoring).

"Remember that when the CPT^® descriptor includes "stereotactic", one may not separately report CPT^® 61781 as the stereotactic work is built into the procedure," Przybylski says.

Codes 61750 (Stereotactic biopsy, aspiration, or excision, including burr hole[s], for intracranial lesion), 61770 (Stereotactic localization, including burr hole[s], with insertion of catheter[s] or probe[s] for placement of radiation source), and 61781 (Stereotactic computer-assisted [navigational] procedure; cranial, intradural [List separately in addition to code for primary procedure]) are for stereotactic biopsy, placement of radiation source, and navigation procedures, respectively.

Answer 3: The correct answer is option d, 61536.

When your surgeon excises an epileptogenic focus, check to see if an electrocorticograph was obtained. You submit code 61534 (Craniotomy with elevation of bone flap; for excision of epileptogenic focus without electrocorticography during surgery) when an EEG is not obtained and code 61536 (Craniotomy with elevation of bone flap; for excision of cerebral epileptogenic focus, with electrocorticography during surgery [includes removal of electrode array]) when an EEG is obtained.