Neurosurgery Coding Alert

Question: Can I use the approach from the skull-base surgery section of the CPT manual and then use a definitive code from the surgery for aneurysm section? For example, could I report 61592 with 61697?


New Hampshire Subscriber

Answer: You should report only the definitive skull- base code. These codes (61580-61619) refer to a -lesion- in their code descriptors. An aneurysm qualifies as a lesion within the definition of the skull-base surgery procedure codes.

Example: In the example you gave, you should report 61592 (Orbitocranial zygomatic approach to middle cranial fossa [cavernous sinus and carotid artery, clivus, basilar artery or petrous apex] including osteotomy of zygoma, craniotomy, extra- or intradural elevation of temporal lobe), and 61606 (Resection or excision of neoplastic, vascular or infectious lesion of infratemporal fossa, parapharyngeal space, petrous apex; intradural, including dural repair, with or without graft) or 61608 (Resection or excision of neoplastic, vascular or infectious lesion of parasellar area, cavernous sinus, clivus or midline skull base; intradural, including dural repair, with or without graft).

Also, reporting 61697 (Surgery of complex intracranial aneurysm, intracranial approach; carotid circulation) would be double-dipping because 61697 includes a non-skull-base approach.