Neurosurgery Coding Alert

Question: What differentiates a "simple" aneurysm from a "complex" aneurysm? Does a difficult removal make the aneurysm complex?

Connecticut Subscriber

Answer: Complex aneurysm codes 61697 (Surgery of complex intracranial aneurysm, intracranial approach; carotid circulation) and 61698 (... vertebrobasilar circulation) describe "aneurysms that are larger than 15 mm or with calcification of the aneurysm neck, or with incorporation of normal vessels into the aneurysm neck, or a procedure requiring temporary vessel occlusion, trapping or cardiopulmonary bypass to successfully treat the aneurysm," according to CPT guidelines.
 
In other words, the aneurysm qualifies as complex either because it is large or because it requires extra effort to control bleeding or prevent further damage to the blood vessels.
 
If the aneurysm does not meet the "complex" definition, you must report the surgery using "simple" aneurysm codes 61700 (Surgery of simple intracranial aneurysm, intracranial approach; carotid circulation) or 61702 (... vertebrobasilar circulation).
 
The "simple" and "complex" definitions do not describe the level of difficulty the surgeon encounters when operating on the aneurysm. Either a simple or complex aneurysm may prove especially difficult or time-consuming to treat. And in either case, you may append modifier -22 (Unusual procedural services) to 61700-61702 for additional reimbursement, if the surgeon appropriately documents the additional level of difficulty.
 
Learn more: For complete information on 61700-61702, look to "What if That 'Simple' Intracranial Aneurysm Isn't So Simple? Here's What to Do," Neurosurgery Coding Alert, January 2005, page 1.