Neurosurgery Coding Alert

Intracranial aneurysms occur in different locations of the brain. Neurosurgeons address them with a variety of techniques and approaches, and CPT 2001 contains well over a dozen codes to describe procedures commonly used. Neurosurgery coders must navigate a complex and confusing maze of highly technical descriptions to find the best code for particular intracranial aneurysm surgeries, and if they choose incorrectly, payment for these very expensive procedures can easily be reduced or denied.

Also, CPT 2001 introduced two new codes (61697 and 61698) while another was altered (61700) in an attempt to make coding more specific for these procedures. It is critical that the coding families into which many of these fall and the guidelines for using them are clearly understood.

CPT 2001 Coding Changes for Intracranial Aneurysms

The new codes and definition revisions have been added to distinguish between simple and complex intracranial aneurysms. Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno, states that these additions may be the result of an increase in submissions to insurance carriers of 61700 (surgery of simple intracranial aneurysm, intracranial approach; carotid circulation) and 61702 (vertebrobasilar circulation) both appended with modifier -22 (unusual procedural services), indicating a more complex surgery. Accordingly, the CPT committee decided to add codes to define what a complex intracranial aneurysm is 61697 (surgery of complex intracranial aneurysm, intracranial approach; carotid circulation) and 61698 (vertebro-basilar circulation). The following text also was added to distinguish between simple and complex intracranial aneurysms: 61697-61698 involve aneurysms that are larger than 15mm 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.

Note: There are circumstances that may still arise in which the procedure is complicated but the work performed does not fit the definition and requirements of 61697 or 61698. In these cases, they would not be considered complex and 61700 or 61702 would still be used with modifier -22 to indicate the additional difficulty of the procedures.

Correct Coding for Skull Base Surgeries

Sandham, who is also a coder specializing in neurosurgical procedures, states that coders are under the impression that the skull base definitive procedure codes (61600-61616) for the resection or excision of a neoplastic, vascular or infectious lesion, cannot apply to an aneurysm because they are normally used for brain tumors. However, if the aneurysm is in the middle cranial fossa and the neurosurgeon performed a skull base approach, they are appropriate. For example, 61613 (obliteration of carotid aneurysm, arteriovenous malformation, or carotid-cavernous fistula by [...]