Neurosurgery Coding Alert

Question:

New Mexico Subscriber

You may consider looking at craniectomy procedures represented by 61343 (Craniectomy, suboccipital with cervical laminectomy for decompression of medulla and spinal cord, with or without dural graft [e.g., Arnold-Chiari malformation) and 61524 (Craniectomy, infratentorial or posterior fossa; for excision or fenestration of cyst). If resection of the cyst was distinct and separate in exposure from the work required to decompress the Chiari malformation, you may be able to report both codes. However, if the cyst excision is within the exposure required to perform the Chiari decompression, it may be considered incidental to the Chiari decompression. If this did require some additional work, this may be reported by appending modifier 22 to the Chiari decompression code.

Tricky: Not sure whether to append modifier 51 (Multiple procedures) or 59 (Distinct procedural service) to the second procedure code? In this case, modifier 59 is appropriate because the craniectomies are performed on a separate lesion. CPT 2010's Appendix A modifier 59 definition states in part that, "Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual."