Neurosurgery Coding Alert

Question:  Our surgeon performed "wrapping of aneurysmal dilation of the left A2 segment." After describing clipping of a middle cerebral artery aneurysm and dilation, the operative note specifies:
 
"Inspection in all directions and mobilization of this vessel further distally revealed that there was no frank aneurysm. There was an aneurysmal dilation of an area of approximately 2 mm in the proximal portion. This was not clippable and was not a true aneurysm. ... Muslin gauze in three strips was used to wrap the area circumferentially."
 
How should I report this?

West Virginia Subscriber

 
Answer: As described, there is no precise code for this procedure. Because the surgeon clipped a middle cerebral artery aneurysm -- and then discovered and inspected the dilation upon further exploration of a branch of the same artery -- report 61700 (surgery of simple intracranial aneurysm, intracranial approach; carotid circulation) with modifier -22 (unusual procedural services) appended to account for the additional time and effort required to wrap the artery. When appending modifier -22, include documentation to justify the request for additional payment.

 -- Clinical and coding expertise for You Be the Coder and Reader Questions provided by 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.