Neurosurgery Coding Alert

Question: I have a denial from a private insurance carrier saying cerebrospinal fluid (CSF) leak is not a usable diagnosis for 63710. Is this so?

Neurosurgery Discussion Group Participant

Answer: You do not mention which insurer, but likely the payer feels that a diagnosis of 997.09 (Other nervous system complications) for CSF leak is not sufficient to support medical necessity for a dural graft (63710, Dural graft, spinal). More significantly, however, 63710 is not the best choice in this circumstance.

Rather, you should report repair of postsurgery CSF leakage due to dural injury with 63707 (Repair of dural/cerebrospinal fluid leak, not requiring laminectomy) or, if laminectomy is required such as when a leak must be approached from above or below the level of a prior surgery or, most commonly, during an initial open approach to repair dura after a complication of a percutaneous spinal procedure 63709 (Repair of dural/cerebrospinal fluid leak or pseudomeningocele, with laminectomy). In each case, the surgeon may place a graft over the damaged area of the dura and suture it in place. These procedures include all components of the surgery, including approach, repair and closure.

Code 63710 describes placement of the dural graft (most commonly synthetic dura substitute or bovine pericardium) only. Because 63710 does not include the approach and closure, it should be reported for dural repair only during another, related procedure.