Neurosurgery Coding Alert

Question: How does one report craniotomy for biopsy of brain lesion when the subsequent pathology report read, "Metastatic carcinoma, poorly differentiated adenocarcinoma, lung primary?" The surgeon did a right sided occipital stealth guided craniotomy and open biopsy.Massachusetts SubscriberAnswer: When performing a biopsy for diagnosing a neoplasm, one must consider whether the biopsy was performed through a burr hole or craniotomy and whether image guidance or stereotactic guidance was required. Typical coding options include 61140 (Burr hole[s] or trephine; with biopsy of brain or intracranial lesion), 61750 (Stereotactic biopsy, aspiration, or excision, including burr hole[s], for intracranial lesion), 61751 (Stereotactic biopsy, aspiration, or excision, including burr hole[s], for intracranial lesion; with computed tomography and/ or magnetic resonance guidance). Since your example instead describes a craniotomy with neuronavigation assistance, the best option would be 61140-22 (Unusual procedural services:....) to describe the additional bony removal and 61781 (Stereotactic computer-assisted [navigational] procedure; cranial, intradural [...]