Neurosurgery Coding Alert

If you think you-re limited to the brain tumor excision code when your neurosurgeon performs this procedure along with an extra- or subdural hematoma evacuation, you could be costing your practice a hefty $1700, based on national averages.

Take this coding quiz challenge to determine when you should consider the evacuation an inherent part of the brain tumor excision -- and when you should report both procedures.

Scenario 1: A 55-year-old woman with a two year history of morning headache and progressive right upper limb weakness awakens one morning to find that she could not see anything to her right and that her left arm and leg were very weak. The neurosurgeon performs emergency surgery via craniectomy to remove a brain tumor. While removing the tumor the surgeon finds an accumulation of clotted blood (hematoma) between the brain and its outer lining in a closely adjacent area, perhaps caused by minor trauma some time before. He evacuates the hematoma before closing the craniectomy. How should you report this?

Scenario 2: The patient arrives at the hospital and presurgical imaging reveals the presence of a tumor on the left side of the brain. A hematoma, as described above, is also present, but at a different location on the right side of the head. The surgeon removes the brain tumor and, through a separate approach, evacuates the hematoma. How should you report this?

Scenario 3: Instead of evacuating a hematoma on a different location, the surgeon enlarges the craniectomy to expose a hematoma that extends beyond the site of the tumor excision. How should you report this?

Scenario 4: The surgeon treats the patient by removing a brain tumor. He has to go back, however, and drain a hematoma that develops. This happens within the global period of the initial surgery. How should you report this?

Have your answers, Turn to page 85 for our experts- solutions.