Neurosurgery Coding Alert

CPT includes 15 codes to describe surgeries for intracranial aneurysms, arterio-venous malformations or vascular disease (61680-61711) and in some cases skull base surgery codes (61580-61598) might apply. With so many choices, appropriate coding for these procedures can seem daunting. A careful reading of CPT can provide the necessary answers. CPT Groups Codes by Type CPT divides codes 61680-61711 into four categories, depending on the reason for surgery. Note that each of these procedures includes craniotomy, when appropriate. The first category, 61680-61692, specifies surgery of intracranial arteriovenous malformation. In this case, arteries and veins are abnormally fused in a tumor-like mass, bypassing the arterial capillaries that normally provide nourishment to the surrounding tissue. The malformation may be supratentorial (i.e., above the tentorium cerebelli, or the upper part of the brain), infratentorial (the lower part of the brain), or dural that is, within the dura (the thick membrane covering the brain). According to Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno, each of these procedures may be simple or complex, as determined by accessibility and difficulty of repair. Note: Neither CPT nor CPT Assistant offers objective criteria to judge a simple versus complex procedure. The surgeon must determine this based on experience and clinical expertise. For example, using angiography, the surgeon determines the presence of an arterio-venous malformation within the left temporal lobe. This qualifies as a complex repair because of the depth of the mass and the delicacy of the surrounding structures, Sandham says. Use 61686 ( infratentorial, complex) to report the procedure. Simple or Complex Aneurysm? The second category of codes (61697-61703) covers repair of intracranial (within the skull) aneurysms. An aneurysm is a bulge or abnormal dilation caused when the walls of a blood vessel weaken. With the addition of 61697 (Surgery of complex intracranial aneurysm, intracranial approach; carotid circulation) and 61698 ( vertebrobasilar circulation) in CPT 2001, these repairs are classified as either simple or complex. According to CPT, a repair is complex if the aneurysm(s) is larger than 15 mm, involves calcification of the aneurysm neck (the constricted portion at the "base" of the aneurysm), incorporates normal vessels into the aneurysm neck, or requires temporary vessel occlusion, trapping or cardiopulmonary bypass to complete the repair. Therefore, to bill successfully for a complex repair, you must make sure that supporting documentation specifically notes one of the above conditions. These repair codes are further differentiated according to the location of the aneurysm. The carotid circulation supplies blood to the anterior (front) and middle portions of the brain (via the carotid artery), while the vertebrobasilar circulation supplies the cerebellum and [...]