Neurosurgery Coding Alert

Question: Our surgeon operated upon a 12 mm carotid aneurysm. There is no mention of any calcification. Can we report this as a complex aneurysm?

Florida Subscriber

Answer: You do not report this aneurysm as complex. Since the aneurysm is only 12 mm in size and there is no calcification, this qualifies for a simple aneurysm. You report code 61700 (Surgery of simple intracranial aneurysm, intracranial approach; carotid circulation) for this procedure, assuming a carotid circulation origin.

Note: You report an aneurysm as complex when any one of the following apply:

1. The aneurysm(s) is larger than 15 mm (1.5 cm).
2. The aneurysm involves calcification of the aneurysm neck (the constricted portion at the “base” of the aneurysm).
3. The aneurysm incorporates normal vessels into the aneurysm neck.
4. The aneurysm requires temporary vessel occlusion, trapping or cardio-pulmonary bypass to complete the rep.

To ensure you do not lose any payment, make sure you check if the procedure needed extended effort or time. For example, read through the procedure note if there were any adhesions that needed to be released. In such a case, your physician may spend more time for the procedure. When your surgeon does unusually complex procedures for a simple aneurysm, you may turn to modifier 22 (Increased procedural services) to describe the extended surgical effort and earn an additional compensation for the same.

Remember: The additional work should represent at least a 25 percent increment in physician work above that typically required. Make sure you document the same. Make sure you have a copy of the surgeon’s operative note. Also document how much additional time was needed and what extra efforts the procedure demanded. Prepare a clear and concise cover letter that describes why the procedure was unusual. Lastly, do not forget to raise a request for additional reimbursement.