Neurosurgery Coding Alert

Question: Our surgeon did a parietal craniotomy for removal of a pineal mass. The complex procedure needed the surgeon to do exploration and excision both below and above the tentorium. A month after the procedure, the patient was returned to the OR for evacuation of a subdural hematoma. Please help to find the right codes.

New York Subscriber

Answer: For excision of the pineal mass using a parietal approach, you report 61510 (Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma). Since your surgeon is excising the tumor through both the supratentorial and infratentorial apporaches, you append modifier 22 (Increased procedural service) to 61510. For the evacuation of the subdural hematoma, you report 61312 (Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural) or 61314 (Craniectomy or craniotomy for evacuation of hematoma, infratentorial; extradural or subdural) depending upon whether the subdural hematoma was above or below the tentorium. Since the patient was returned to the OR to evacuate a subdural hematoma following the pineal mass excision, you append modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) to 61312 or 61314.