Neurosurgery Coding Alert

Question: How do we report when our surgeon does a stereotactic pterional osteoplastic craniotomy with resection of clinoidal wing mass along with intraoperative electrophysiological monitoring with SSEPs and motor evoked potentials?

Alaska Subscriber

Answer: Assuming the clinoid wing mass was a meningioma, you report code 61512 (Craniectomy, trephination, bone flap craniotomy for excision of meningioma, supratentorial). In general, you should not report skull base codes if a craniotomy code specific to the procedure exists. 

Check if your surgeon adopted a skull base approach. If so, pair the appropriate approach code for the location of the neoplasm (anterior vs. middle fossa, intradural vs. extradural) with the definitive resection code of the same anatomical site. 

Since your surgeon is describing both microdissection and stereotactic navigation, you may also report the add-on codes +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) for the microsurgical dissection and +61781 (Stereotactic computer-assisted [navigational] procedure; cranial, intradural [List separately in addition to code for primary procedure]) for the navigational procedure.