Neurosurgery Coding Alert

Question: Our neurosurgeon completed a suboccipital craniectomy, C1 laminectomy, and resection of venous aneurysm for a patient with subarachnoid hemorrhage. How do I code this?

Maryland Subscriber

Answer: Look at each procedure within the encounter for easier coding:

• For treatment of the posterior circulation aneurysm, consider 61698 (Surgery of complex intracranial aneurysm, intracranial approach; vertebrobasilar circulation) if it meets the criteria of a complex aneurysm. These criteria include size more than 15 mm, calcification of the aneurysm neck, incorporation of normal vessels in the aneurysm neck, need for temporary occlusion, trapping or cardiopulmonary bypass. Otherwise, choose 61702 (Surgery of simple intracranial aneurysm; vertebrobasilar circulation).

• If your physician used a stereotactic approach and/or an operating microscope, include +61795 (Stereotactic computer-assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal [List separately in addition to code for primary procedure]) and +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) as appropriate.