Neurosurgery Coding Alert

Question: Our surgeon did a craniotomy and placed a clip over a large anterior communicating artery aneurysm, 17 mm in size. Further, he also separately exposed another 10 mm aneurysm in the posterior communicating artery. How do we report this?

Florida Subscriber

Answer: You report 61697 (Surgery of complex intracranial aneurysm, intracranial approach; carotid circulation) for the anterior artery aneurysm which was 17 mm in size and 61700 (Surgery of simple intracranial aneurysm, intracranial approach; carotid circulation) – 59 (Distinct procedural service) for the second aneurysm that was 10 mm in size. In contrast, if the exposure required to clip one aneurysm provides most of the access to a second associated aneurysm nearby, this would best be reported with one code and the 22 (Increased procedural service) modifier.

Multiple units: When your surgeon clips more than one aneurysm in the same operative session, you can report both the aneurysms. You may append modifier 59 (Distinct procedural service) to imply that the two aneurysms are independent and separate. Make sure you keep documentation to support that the aneurysms are in separate anatomical locations requiring separate surgical exposures.

Caveat: Not in all cases when your surgeon treats a second aneurysm via the same craniotomy, can you report two units of 61700. There isn’t an absolute rule that guides your choice of multiple choices. Always see what the documentation supports and if you can report multiple units with appropriate modifiers (modifiers 22, 52, 59). It is best you consult your surgeon to determine the extent of separate exposure required to treat more than one aneurysm. This will help you to select the most appropriate modifiers.