Neurosurgery Coding Alert

Question: Before performing surgery for a complex intracranial aneurysm, the surgeon performed an angiogram to identify the location of the aneurysm and discovered that it was in the vertebrobasilar circulation. The surgeon then created an incision in the scalp over the area of the aneurysm and retracted the scalp to expose the bone. He used a surgical drill to make a burr hole in the patient’s skull. He inserted a craniotome through the burr holes and cut between adjacent burr holes to create a bone flap. The surgeon removed the bone flap to expose the dura and incised the dura to expose the underlying brain. He dissected down to expose the aneurysm, which measured 17mm. The surgeon exposed the vessels and identified the aneurysm’s neck. He used temporary occlusion clips as he dissected vessels that were part of the aneurysm’s neck. Which CPT^® code should I report for this procedure?

California Subscriber

Answer: You should report 61698 (Surgery of complex intracranial aneurysm, intracranial approach; vertebrobasilar circulation) for this procedure because the complex aneurysm was located in the vertebrobasilar circulation.

When you choose codes for intracranial aneurysms, you must know whether the aneurysm is simple or complex. When differentiating between simple and complex aneurysms, remember that complex aneurysms must meet at least one of the following criteria:

• The aneurysm is larger than 15mm.
• The aneurysm involves calcification of the aneurysm neck.
• The aneurysm incorporates normal vessels into the neck of the aneurysm.
• The aneurysm procedure requires temporary vessel occlusion, trapping, or cardiopulmonary bypass to successfully treat the aneurysm.

As you can see from your question, the aneurysm measured at 17mm and treatment included temporary clipping, so it qualifies as complex.