Neurosurgery Coding Alert

Question: How should I report bilateral frontal craniotomy for evacuation of subdural hematomas? My doctor wants to report 61312-50, but I am not sure if modifier -50 is appropriate for this procedure.


Colorado Subscriber

Answer: Your reservations are well-founded: You should not report modifier -50 (Bilateral procedure) with 61312 (Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural), according to the Medicare Physician Fee Schedule database. The database includes a "0" in the "BILAT SURG" column for 61312, which means that you should not claim a bilateral surgery using modifier -50.

In this case, if the surgeon did indeed perform frontal craniotomy at two locations on either side of the skull, you should report 61312 and 61312-59 (Distinct procedural service). Modifier -59 on the second unit of 61312 tells the payer that the second craniectomy occurred at a separate anatomic location than the first craniectomy.

To further differentiate the craniectomies, you may also append modifiers -LT (Left side) and -RT (Right side). Be sure to have on hand supporting documentation that justifies your coding by noting the existence of two separate hematomas and the two separate approaches necessary to treat the hematomas.