Neurosurgery Coding Alert

Question: Our surgeon performed excision of a brain tumor followed by hematoma evacuation during the same session. I reported 61510 for the excision and 61312 for the evacuation, but the payer denied 61312. Shouldn't the surgeon get reimbursed for both procedures?


Washington Subscriber

Answer: The answer is "maybe," depending on the circumstances of the surgery.

The National Correct Coding Initiative (NCCI) bundles 61312 (Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural) to 61510 (Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma) with the explanation that evacuation of a hematoma is incidental to tumor excision at the same location.

Therefore, if you report 61510 and 61312 for the same operative session, Medicare payers and other insurers who follow NCCI guidelines will only reimburse the surgeon for excision (61510), as you learned in your case.

On occasion, however, the tumor and hematoma occur at different locations within the skull. In these cases, hematoma evacuation adds time and difficulty to the procedure, and you may expect additional compensation.

Your best bet in these situations is to let common sense prevail: Did the evacuation require a separate approach, extensive extension of the initial approach, and a separate closure? If so, you can treat it as an additional procedure. If the evacuation involved only limited suction of hematoma present in the area of the tumor excision and minimal additional time and effort, don't code it separately.

You do not indicate which was true in your case, but if it was the former situation, you may report both 61510 and 61312 by appending modifier -59 (Distinct procedural service) to 61312 to indicate that the procedures occurred at different anatomic locations.

Note also that you may use HCPCS level II location modifiers -LT (Left side) and -RT (Right side) to make your claim more specific and further support separate payment for hematoma evacuation and tumor excision. For example, if the surgeon removes a tumor on the left side and evacuates a hematoma on the right, you may report 61510-LT and 61312-59-RT to indicate separate locations.

To avoid payment delays, file the claim manually and include a copy of the operative report, along with a letter describing the circumstances of the surgery and the separate nature of the excision and evacuation procedures.