Neurosurgery Coding Alert

Report 61700 and 61702 for simple aneurysms.

When you report intracranial (within the skull) aneurysms, you must look for specific information in your neurosurgeon’s medical documentation to choose the correct codes. This information includes whether the aneurysm is complex or simple and the exact location of the aneurysm.

Read on to always submit clean intracranial aneurysm claims in your office.

Tip 1: Identify the Intracranial Aneurysm’s Location

You will see two possible intracranial aneurysm locations in your neurosurgeon’s medical documentation — carotid circulation and vertebrobasilar circulation.

If the intracranial aneurysm is located in the carotid circulation, then you should report the following codes:

• 61697 (Surgery of complex intracranial aneurysm, intracranial approach; carotid circulation) for a complex aneurysm.
• 61700 (Surgery of simple intracranial aneurysm, intracranial approach; carotid circulation) for a simple aneurysm

Don’t miss: The carotid circulation supplies blood to the anterior part of the brain. The branches of the carotid circulation include the middle cerebral, anterior choroidal artery (AC), and ophthalmic arteries.

On the other hand, if the patient’s intracranial aneurysm is located in the vertebrobasilar circulation, then you would report the following codes:

• 61698 (Surgery of complex intracranial aneurysm, intracranial approach; vertebrobasilar circulation) for a complex aneurysm
• 61702 (Surgery of simple intracranial aneurysm, intracranial approach; vertebrobasilar circulation) for a simple aneurysm.

Don’t miss: The vertebrobasilar circulation supplies the posterior part of the brain. The branches of the vertebrobasilar circulation include the posterior cerebral and cerebellar arteries.

“The carotid circulation includes the carotid, ophthalmic, anterior cerebral, anterior choroidal, anterior communicating, anterior cerebral and middle cerebral arteries,” explains 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. “Although described as a “posterior” vessel by name, the posterior communicating artery links the posterior circulation to the anterior circulation. The vertebrobasilar circulation includes the vertebral, basilar, posterior inferior cerebellar (PICA), anterior inferior cerebellar, and superior cerebellar arteries.”

Tip 2: Determine Whether Aneurysm is Complex by Meeting Specific Criteria

Once you figure out the location of the aneurysm, you will need to know whether the aneurysm is simple or complex.

Complex aneurysms must meet at least one of the following criteria:

• The aneurysm is larger than 15mm.
• The aneurysm involves calcification of the aneurysm neck.
• The aneurysm incorporates normal vessels into the neck of the aneurysm.
• The aneurysm procedure requires temporary vessel occlusion, trapping, or cardiopulmonary bypass to successfully treat the aneurysm.

As mentioned above, you would report codes 61700 and 61702 for simple aneurysms. On the other hand, you should report 61697 and 61698 for complex aneurysms.

Tip 3: Use Examples to Differentiate Between Simple and Complex Aneurysms

Take a look at the following examples to help you understand when an aneurysm would be considered simple and when an aneurysm would be considered complex.

Simple aneurysm example: The surgeon discovers that a patient has an aneurysm located in her carotid circulation. The surgeon performs visualization of the right posterior communicator as well as the neck of the aneurysm, which was extending laterally in view but in fact was projecting directly inferior. The surgeon finds that the third cranial nerve is associated with and slightly superior to the dome of the aneurysm. He then clips the aneurysm with an 11-mm straight clip across the aneurysm neck with good occlusion.

You should report 61700 for this procedure because the simple aneurysm was located in the carotid circulation.

Complex aneurysm example: The surgeon performed an angiogram before this procedure to identify the location of the aneurysm and discovered that it was in the vertebrobasilar circulation.

The surgeon creates an incision in the scalp over the area of the aneurysm and retracts the scalp to expose the bone. He then uses a surgical drill to make a burr hole in the patient’s skull. He inserts a craniotome through the burr holes and cuts between adjacent burr holes to create a bone flap. The surgeon then removes the bone flap to expose the dura and incises the dura to expose the underlying brain. He dissects down to expose the aneurysm, which measures 20mm. The surgeon exposes the vessels and identifies the aneurysm’s neck. He uses temporary occlusion clips as he dissects vessels that are part of the aneurysm’s neck. He also finds a calcified wall structure, so he incises and sutures the aneurysm. At the end of the procedure, he obtains hemostasis, closes the dura and replaces and secures the bone flap.

You should report 61698 for this procedure because the complex aneurysm was located in the vertebrobasilar circulation.