Neurosurgery Coding Alert

Question: What is the correct code to describe placement of a drain for intraoperative ventricular decompression with a craniotomy?

Kentucky Subscriber
 
Answer: If the surgeon places the ventriculostomy via the craniotomy incision or the same burr hole, the drain is included in the craniotomy (e.g., 61304-61545), and therefore you may not report the procedure separately.

If the surgeon must create a separate twist drill hole or burr hole to place the ventriculostomy, you may choose either 61107 (Twist drill hole for subdural or ventricular puncture; for implanting ventricular catheter or pressure recording device) or 61210 (Burr hole[s]; for implanting ventricular catheter, reservoir, EEG electrode[s] or pressure recording device [separate procedure]), as appropriate, in addition to the craniotomy. Your documentation should explain clearly that the surgeon created a separate twist drill or burr hole to place the drain, and you should append modifier -59 (Distinct procedural service) to 61107/61210 to indicate that the ventriculostomy was distinct from the craniotomy.