Neurosurgery Coding Alert
Consider 61250 for Burr Hole
Question: Our surgeon performed a right frontal burr hole with evacuation of pneumocephalus. The patient had developed an extremely large amount of air in the subdural space with marked compression of the cerebral hemi-spheres following evacuation of a subdural hematoma at another facility. I am considering 61154 but I-m not sure if it's accurate.
Florida Subscriber
Answer: You should report 61250 (Burr hole[s] or trephine, supratentorial, exploratory, not followed by other surgery) for this service, assuming that the neurosurgeon did not perform any additional surgeries to cause the air to escape.
You should not report 61154 (Burr hole[s] with evacuation and/or drainage of hematoma, extradural or subdural) because this code refers to a hematoma drainage and your surgeon was instead allowing air to escape.
Neurosurgery Coding Alert
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