Neurosurgery Coding Alert

Confirm if a simple, compound, or comminuted fracture was repaired.

You’ll be well on the way to selecting the right code for surgical elevation of depressed skull fractures if you can confirm fracture type, any debridement, and dural repair.

Confirm Surgical Management for Depressed Skull Fractures

For surgical management of a depressed skull fracture, your surgeon will incise the scalp to access the skull fracture and then reassemble the broken fragments of the skull bone(s). This may need metal plates, screws, or sutures. To keep the original shape of the skull, your surgeon may use metallic mesh or bone cement. You can look for these steps in an operative note to confirm surgical management of a depressed skull fracture.

Why surgical repair? Your surgeon may opt for a surgical repair of a depressed skull fracture if the depression is greater than 8-10mm or if it is greater than the thickness of the skull. In addition, if there is any leak of cerebrospinal fluid, edema in the underlying brain tissues, or signs of brain dysfunction, your surgeon may perform a surgical correction of the depressed fracture. Any open depressed fractures in the skull are often treated surgically. “There are a number of variables that a neurosurgeon considers when deciding whether to surgically treat a depressed skull fracture, including anatomical location, associated brain injury, cosmetic consequences, and duration of an open scalp laceration,” says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Report 62000 for Simple Skull Fractures

When your surgeon repairs a simple skull fracture, you report code 62000 (Elevation of depressed skull fracture; simple, extradural).

Example: You may read that a 50-year old patient was brought to the hospital after having been hit by a rod; your surgeon did an examination to locate redness, swelling, bruises, but no laceration over the left frontal region. Further, the patient developed motor weakness in the right lower limb during the period of observation. The computed tomography report in such a patient may show ‘depressed fragment of frontal bone associated with hypodensities in the adjacent brain parenchyma,’ with the hypodensities suggestive of edema.

“Closed depressed skull fractures may or may not be associated with dural lacerations,” says Przybylski. “It is important to review the details of the operative note regarding operative findings to differentiate among simple and compound fracture repairs as well as those entailing dural repair and/or debridement of injured brain tissue.

In this case, your surgeon may decide to elevate the fracture as there is a clear brain dysfunction associated. If a scalp laceration is not noted and no dural repair was performed, you report the elevation with 62000.

What “simple” means: The code descriptor for 62000 clearly specifies that the code is for simple depressed fractures. The term ‘simple’ here implies a closed fracture. Hence, you report 62000 when you confirm in the operative note that there was no laceration or wound in the scalp region overlying the skull fracture.

Hint: In the operative note, you confirm elevation of the skull fracture when you read that your surgeon elevated any piece(s) of bone that had been pressed inwards and repositioned them to their correct position. If necessary, your surgeon may use a metal wire or plates to maintain the elevated piece(s) of the skull fracture. Your surgeon may then close the skin with stitches or staples.

What to Report for Compound and Comminuted Fractures

When your surgeon stabilizes and repositions a compound or comminuted depressed skull fracture, you report code 62005 (Elevation of depressed skull fracture; compound or comminuted, extradural).

Example: You may read in the operative note that your surgeon performed an elevation of compound, comminuted, depressed skull fracture and also did methylmethacrylate cement cranioplasty. In this case, you can confidently report code 62005. “Compound skull fractures describe fractures associated with an open scalp wound. Comminuted fractures may or may not be associated with an open scalp laceration,” says Przybylski.

Confirm Any Repair or Debridement

For any depressed skull fracture, whether simple, compound, or comminuted, you should always confirm if your surgeon does any repair of the dura or debrides brain tissue. For those services, turn to code 62010 (Elevation of depressed skull fracture; with repair of dura and/or debridement of brain).

Documentation tip: Debridement of devitalized tissues and repair of dural defects is an integral part of operative management of depressed skull fractures when using CPT® 62010. Do not forget to check for any debridement or repair in the operative note.

“There may be circumstances in which a depressed skull fracture is associated with a subdural or intraparenchymal hematoma requiring craniectomy or craniotomy,” says Przybylski. “In such circumstances, you do not separately report the treatment of the depressed fracture is an incidental part of the closure of the more extensive procedure of craniotomy for evacuation of the subdural or intraparenchymal hematoma.”