Neurosurgery Coding Alert

Question: Our surgeon treated a patient for evacuation of an intracranial hematoma. To minimize the rise in intracranial pressure due to swelling, she opted not to replace the cranial bone flap immediately. Instead, she created a pocket in the abdominal wall and placed the bone flap in the subcutaneous space for later use.

Five weeks later, the surgeon returned the patient to the operating room. She accessed the previously stored graft from the subcutaneous pocket in the abdomen, then performed final repair of the initial craniectomy site.

I-m not sure where to begin: What codes do I need? Should I use modifiers for the follow-up surgery?


New York Subscriber

Answer: For the first session, you would report the appropriate hematoma evacuation code (for instance, 61312, Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural) as the primary procedure. In addition, you would report add-on code +61316 (Incision and subcutaneous placement of cranial bone graft [list separately in addition to code for primary procedure]) to describe temporary placement of a cranial bone graft into a distant subcutaneous site for future retrieval. You need not append any modifiers to this claim.

For the second session, the primary procedure is bone flap replacement (62143, Replacement of bone flap or prosthetic plate of skull). However, the surgeon must also access and remove the previously stored graft from the subcutaneous pocket in the abdomen. To claim this procedure, you should report +62148 (Incision and retrieval of subcutaneous cranial bone graft for cranioplasty [list separately in addition to code for primary procedure]) in addition to 62143.

Code 62148 includes repair of the temporary placement site. Therefore, you should not charge separately for wound repair in addition to 62148.

Keep in mind that if the cranial repair occurs during the initial surgery's 90-day global period, you should append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to the appropriate cranial repair code.

Therefore, because the graft replacement in this case occurred within the global period of the hematoma evacuation, you would report the two sessions as follows:

Session 1:
61312
61316

Session 2:
62143-58
62148-58.

Technical and coding guidance for You Be the Coder and Reader Questions provided by Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, N.J.