Neurosurgery Coding Alert

Question: One of our surgeons did a craniotomy, (61313) along with a temporal lobectomy without electrocorticogaphy. I cannot find a code for the temporal lobectomy. Is there one, or is it included in the craniotomy code?

Betsy OConnor
Bryn Mawr, Pa.

Answer: Code 61313 (craniectomy or craniotomy for evacuation of hematoma, supratentorial; intracerebral) already includes intracerebral evacuation of the hematoma, says 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, and a coder who specializes in neurosurgical procedures. Removal of damaged brain, usually bruised brain that is suctioned out, adds some time but is not an additional procedure (as would be the case perhaps if a second and separate craniotomy with temporal lobectomy was performed). If the lobectomy adds significant time and effort, append the -22 modifier (unusual procedural services) to CPT code 61313.

Note: For additional information on billing with modifier -22, see the article on page 73 of the September issue of Neurosurgery Coding Alert entitled Increase Pay Up With Proper Documentation for Modifier -22.