Neurosurgery Coding Alert

Question: Our surgeon removed a basal cell carcinoma that extended below the skin to the skull, which required partial excision of the outer table of the skull. How can we code for this?


Pennsylvania Subscriber

Answer: In this case, you should report 61500 (Craniectomy; with excision of tumor or other bone lesion of skull) and append modifier 52 (Reduced services).

The craniectomy code assumes a full-thickness procedure, and applying modifier 52 acknowledges that the surgeon only excised a portion of the skull's outer table.

When you append modifier 52 to a claim, you should tell the payer why. Include a cover letter - as well as the operative report - with your claim to explain the extenuating circumstances that caused the physician to reduce the procedure.

You need not lower your fees when submitting a claim with modifier 52. Rather, provide as much documentation as possible and allow the payer to make a determination based on the information you submit.