Neurosurgery Coding Alert

Answer: Craniotomy and craniectomy are both surgical procedures that involve the removal of a part of the skull to access the brain. In summary, a craniotomy involves temporarily removing a bone flap to access the brain for specific surgical procedures followed by replacement of the bone flap; while a craniectomy involves removing a portion of the skull without replacement of the removed bone. This may be performed to provide more space for the brain in emergency situations.

Here are the differences between the two:

Craniotomy: You’ll code craniotomies with codes from the 61304 (Craniectomy or craniotomy, exploratory; supratentorial) through 61571 (Craniectomy or craniectomy, with treatment of penetrating wound of brain) code set.

In a craniotomy, a bone flap is temporarily removed from the skull to access the brain. This procedure allows the surgeon to perform various brain surgeries, such as tumor removal, aneurysm repair, or epilepsy treatment. After the surgery is completed, the bone flap is usually replaced and secured with plates, screws, or wires. A craniotomy is often performed when the goal is to access and treat a specific area of the brain.

Craniectomy: You’ll code craniectomies with the same codes from the same 61304 through 61571 code set.

In a craniectomy, a portion of the skull is removed without replacement, rather than just a bone flap. Unlike a craniotomy, the removed bone is not replaced immediately after the surgery. Craniectomy may be done in emergency situations, such as when there is significant brain swelling or bleeding, and the brain needs more space to expand. The removed bone may be stored for later re-implantation, but in some cases, it may not be reattached at all. Craniectomy provides more room for the brain to swell and reduces the risk of increased pressure on the brain. In addition, suboccipital surgery is often done using a craniectomy rather than craniotomy technique.