Neurosurgery Coding Alert

Warning: Some surgeons don't use CPT terms to describe approach procedures

When a neurosurgeon performs a skull base surgery, deciding on the correct approach code can confuse even the most competent coders.

There are 14 codes to choose from when your surgeon performs this procedure, and they may be used singly or in combination, so you-ll often need to check the notes thoroughly before you can decide on the correct code. Also, there are times when the physician's notes may not describe the procedure in CPT terms, further complicating the code-choice conundrum.

You can combat unclear skull base surgery claims with a solid knowledge of anatomy and good communication between the physicians and the coding department. Step 1: Locate the Area the Surgeon Accessed  The first fact you-ll need to find on the encounter form for skull base surgery approach claims is the area in which the surgeon entered the cranial fossa. The skull base is divided into three parts: anterior cranial fossa, middle cranial fossa, and posterior cranial fossa, says Jackie Morton, coder at West Virginia's Neurological Associates Inc. Since the surgeon can access any of these fossa regions through several entry points, you-ll need to decide on the area the surgeon targets before addressing the point of entry, Morton says.

-First, I determine if the exposure was of the anterior, middle or posterior cranial fossa, by using the anatomical areas that are involved (i.e., where the dissection led to). Then I like to determine the method of approach,- starting with where the initial incision was made,- says Jennifer Schmutz, CPC, health information coder with Neurosurgical Associates LLC in Salt Lake City.

Example: The operative notes state that the surgeon accessed the anterior cranial fossa using craniofacial approach. First, you can narrow your code choices to the Anterior Cranial Fossa section of CPT (61580-61586) since the notes indicate that the surgeon accessed this area.
 
Once you-ve addressed the access area, narrow your choices further by only considering the codes from that section that use the craniofacial approach:

- 61580 -- Craniofacial approach to anterior cranial fossa; extradural, including  lateral rhinotomy, ethmoidectomy, sphenoidectomy, without maxillectomy or orbital enteration

- 61581 -- ... extradural, including lateral rhinotomy, orbital exenteration, ethmoidectomy, sphenoidectomy and/or maxillectomy

- 61582 -- ... extradural, including unilateral or  bifrontal craniotomy, elevation of frontal lobe(s), osteotomy of base of anterior cranial fossa

- 61583  -- ... intradural, including unilateral or bifrontal craniotomy, elevation or resection of frontal lobe, osteotomy of base of anterior cranial fossa. However, you-re not ready to choose the proper approach code yet. Step 2: Answer Intra/Extradural Question Next Once you have settled on a region of the cranial fossa and an approach method, you-ll need to find out if the neurosurgeon used intradural or extradural dissection during the procedure.

The dissection method should be recorded somewhere in the op [...]