Neurosurgery Coding Alert

Question: Some of our physicians suggested we submit the skull base codes for a transnasal endoscopic resection of a clival lesion, but I thought those were intended for open procedures. What is the correct option?

Illinois Subscriber

Answer: You're correct in steering clear of skull base codes for an endoscopic procedure. Your best option is 64999 (Unlisted procedure, nervous system). Comparison: Some coders try to report 62165 (Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or transsphenoidal approach) for the procedure you describe. The clival lesion is below the pituitary area, so you should use only 62165 for a pituitary tumor or Rathke's cleft cyst. Submit 64999 and compare it to 62165 for reimbursement purposes.