Neurosurgery Coding Alert

Question: Can you help with this scenario? One of our neurosurgeons performed drainage and cleaning of the wound, debridement, replacement of the bone, and fixation of the fracture.

The operative report states:

The old incision is reopened after Marcaine injection without epinephrine. We visualized the displacement of the bone. No evidence of the infection at this time. We decided to remove the bone and we did not see any drainage. We took a culture of the granulation tissue and brown tissue. We sent this for Gram stat and the first Gram came back no bacteria. Small white blood cell counts. We re-irrigated multiple times. We cleaned well the wound. We cleaned well the bone and we decided to replace the bone in place with better fixation of the fracture. We fixed the dura with the bone flap. After multiple irrigations, put a Jackson-Pratt in place and the skin is closed in the usual fashion.

Answer: The scenario does not describe the location of treatment, but presumably reflects a previous repair of traumatic skull fracture being re-explored with incision and drainage for suspected infection. Had the bone flap been removed, then consider 62142 (Removal of bone flap or prosthetic plate of skull.) However, given that only incision and drainage without bone removal was performed, you may be limited to 10180 (Incision and drainage, complex, postoperative wound infection.) You may consider appending 22 modifier (Increased procedural services) to reflect the additional work of applying better fixation.