Neurosurgery Coding Alert

Example: You may read that, for a patient with intracranial subdural hemorrhage and subfalcine herniation who underwent an emergent decompressive parietal craniectomy, your surgeon did a left parietal cranioplasty after retrieval of the cranial bone graft that was placed in a subcutaneous pocket in the abdomen. You should make sure you report all the steps for this service.

Step 1: Report the primary procedure: You report the primary procedure that your surgeon does to address the diagnosed condition in the patient. In the example above, you would report code 61312 (Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural) as the primary procedure because your surgeon is doing a decompressive craniectomy in a patient with a subdural hematoma.

Step 2: You then report the placement of the cranial bone graft in the subcutaneous pocket in the abdomen. You use the add-on code +61316 (Incision and subcutaneous placement of cranial bone graft [list separately in addition to code for primary procedure]) to describe temporary placement of a cranial bone graft into a distant subcutaneous site for future retrieval. "This is typically done when brain swelling is anticipated. Many hospitals are no longer willing to maintain frozen bone flaps for later implantation because of concerns about contamination among other reasons," says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Since +61316 is an add-on code, you always report it with a code for the primary procedure. Some of the primary procedure codes may include codes like 61304 (Craniectomy or craniotomy, exploratory; supratentorial) -- 61571 (Craniectomy or craniotomy; with treatment of penetrating wound of brain), and 61680 (Surgery of intracranial arteriovenous malformation; supratentorial, simple) -- 61705 (Surgery of aneurysm, vascular malformation or carotid-cavernous fistula; by intracranial and cervical occlusion of carotid artery).

Note: You report +61316 only when your surgeon documents the temporary placement of the cranial bone flap in the subcutaneous pocket for safe storage. You do not report this code if the flap was freeze- dried. You have no specific code for reporting the freeze-drying of the flap. "There is no code for placing a flap in the freezer given the absence of associated physician work," says Przybylski.