Neurosurgery Coding Alert

Question: How do we report a suboccipital craniectomy and C1-3 laminectomy for removal of intradural extramedullary tumor?

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Answer: While a far lateral transcondylar skull base approach with resection of upper cervical segments for access is reported with skull base approach and definitive procedure codes, the brief description provided implies a direct posterior approach. There is no single code that describes suboccipital craniectomy and cervical laminectomy for resection of a presumably craniovertebral junction meningioma.

If the tumor was primarily spinal, then you would report 63280 (Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, cervical), possibly appended with 22 (Increased Procedural Services) modifier if a significant craniectomy is performed for junctional exposure.

If the tumor extended significantly intracranially as well as intraspinally, then one would report 61519 (Craniectomy for excision of brain tumor, infratentorial or posterior fossa; meningioma) and 63280 (Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, cervical) -51 (Multiple procedures). If the operating microscope was used for microdissection, one could additionally report 69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]).