Neurosurgery Coding Alert

Question: My doctor performed a skull-base surgery on a patient to remove a lesion. His op notes specify that he used an orbitocranial approach to access the anterior cranial fossa with intradural dissection. Is 61592 the appropriate code for me to report?


Ohio Subscriber

Answer: If you focus first on the approach your physician took with the surgery, you could mistakenly choose 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) as the correct code.

If you look more closely, however, you-ll see that 61592 applies to the middle cranial fossa. In this case, you should narrow your code selection to the 61580-61586 category, which applies specifically to the anterior cranial fossa.

Next, you should determine whether the surgeon performs dissection intra- or extradurally. Because the op note specified intradural, rule out all codes in this category that specify an extradural approach. This helps you narrow your code selection to 61583 (Craniofacial approach to anterior cranial fossa; intradural, including unilateral or bifrontal craniotomy, elevation or resection of frontal lobe, osteotomy of base of anterior cranial fossa) or 61586 (Bicoronal, transzygomatic and/or LeFort I osteotomy approach to anterior cranial fossa with or without internal fixation, without bone graft).

You should get more information from the surgeon to determine exactly where the dissection around the orbit occurred, but since 61583 has the more general code description, it is most likely the correct choice.