Neurosurgery Coding Alert

Mark down codes 62120 and 62121 for encephalocele repair services.

Your neurosurgeon repairs an encephalocele, a protrusion of the brain through a defect in the patient’s skull. Do you know that you should carefully check the notes to ensure you give the neurosurgeon credit for every procedure he performs?

Answer the following questions to make sure you don’t leave well-deserved payment on the table.

See Causes of Encephalocele And Treatment Options

Question 1: What causes encephalocele and what are the treatment options?

Answer 1: “This [encephalocele] can occur from developmental defects of the meninges and skull as well as a consequence of trauma or surgical intervention,” says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey. “Treatment typically includes repair of the dural defect as well as the bony defect.”

Dive into These CPT^® Codes

Question 2: What CPT^® codes can we look to when reporting a repair of encephalocele?

Answer 2: When reporting repair of encephalocele, you must check whether the neurosurgeon repaired the encephalocele the vault or base of the skull. You would then choose from the following codes:

• 62120 (Repair of encephalocele, skull vault, including cranioplasty)
• 62121 (Craniotomy for repair of encephalocele, skull base).

Check Out These Steps for 62120

Question 3: Our neurosurgeon performed a 62120 service. Can you explain what steps he adopted to repair the encephalocele so I can better understand the procedure?

Answer 3: When performing a 62120 service, the surgeon will take the following steps to repair the encephalocele.

Step 1: Incision: The surgeon makes an incision in the patient’s scalp to expose the area around the cerebral herniation. Then, the surgeon separates the protruding cerebral tissue from the scalp tissue, taking care to minimize blood loss and avoid damaging the herniated brain tissue.

Step 2: Burr hole:  With the use of a surgical drill, the surgeon will make one or more burr holes and insert a craniotome to raise a bone flap and access the patient’s brain.

Step 3: Removal of cerebral tissue: He then carefully removes any nonfunctional cerebral tissue and returns the brain tissue and any membranes or fluids that have come out of the gap in the skull back into the skull.

Step 4: Repair of encephalocele:  He removes the sac that surrounded the encephalocele and closes the damaged dura with sutures and graft material.

Step 5: Closure: He may apply a synthetic graft with or without a tissue sealant, such as fibrin glue, over the dural suture line to help close the tear and create a watertight seal; replace the bone flap, and close the skull and scalp.

Decipher This Encephalocele Example

Question 4: Our surgeon performed a bone flap craniotomy in the left middle cranial fossa using an extradural approach, and repair of encephalocele using stereotactic navigation software and an operating microscope. We also confirmed in the operative note that the surgeon inserted a lumbar drain. What CPT® codes should we report?

Answer 4: When you report repair of encephalocele, you should not only report the bone flap craniotomy and repair of encephalocele. You should also report any separate drains placed and microdissection that your surgeon performed. “The additional work of the navigation, microdissection, and separate site lumbar drain placement are separately reportable services,” Przybylski says.

You would report the following codes for the above example:

• 62120 for the encephalocele repair
• 62272 (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter)) for the lumbar drain insertion
• +61781 (Stereotactic computer-assisted (navigational) procedure; cranial, intradural (List separately in addition to code for primary procedure)) for the navigation software
• +69990 (Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure)) for the surgical microscope.

Discover These ICD-10 Codes For Encephalocele Repair

Question 5: What ICD-10 codes do we have to look to for encephalocele repair?

Answer 5: You have the following ICD-10 choices for encephalocele, depending upon which region of the brain the surgeon repaired:

• Q01.0 (Frontal encephalocele)
• Q01.1 (Nasofrontal encephalocele)
• Q01.2 (Occipital encephalocele)
• Q01.8 (Encephalocele of other sites)
• Q01.9 (Encephalocele, unspecified).