Neurosurgery Coding Alert

When a patient undergoes a craniectomy/craniotomy, the scramble is on for coders to choose the correct surgical code to represent the procedure.

Some craniectomy/craniotomy procedures are performed almost exclusively for a single medical condition, while others are more specific to the type of injury the patient suffered.

Check out this primer on four craniotomy/craniectomy codes that you might need for your neurosurgeon’s services.

Epilepsy-Related Craniotomies Likely Mean 61566, 61567

If your surgeon performs a craniotomy on a patient with epilepsy, they will likely perform one of two surgery types. The first is amygdalohippocampectomy, which you’d code with 61566 (Craniotomy with elevation of bone flap; for selective amygdalohippocampectomy).

Definition: During amygdalohippocampectomy, the surgeon removes the amygdala and hippocampus. This surgery is often performed to treat epilepsy, particularly those types that originate in the temporal lobe of the brain.

The surgeon might also treat the patient’s epilepsy using multiple subpial transections, which you’d report with 61567 (… for multiple subpial transections, with electrocorticography during surgery).

Definition: During subpial transections, the surgeon makes small transections in the subpial tissue, typically in the neocortex. These cuts are made parallel to the surface of the brain and are intended to interrupt the spread of abnormal electrical activity that can cause seizures.

ICD-10 coding: There aren’t going to be a lot of diagnosis codes that payers will accept for 61566 or 61567. The patient will almost certainly have an epilepsy diagnosis, which will come from the G40.- (Epilepsy and recurrent seizures) code set. Check with your payer for a complete list of diagnoses that are covered for 61566 and 61567 surgery.

Example: An otherwise healthy 25-year-old patient develops a partial complex seizure. They recall being told that they had a febrile seizure when they were a child. They were initially responsive to an anticonvulsant, but then developed recurrent seizures. Additional medical therapy was instituted with various antiepileptic combinations. Despite many months of treatment, the patient continued to experience frequent recurrent seizures and was evaluated at a comprehensive epilepsy center. She was found to have left medial temporal sclerosis on magnetic resonance imaging (MRI), and electroencephalogram (EEG) mapping confirmed that their seizures were originating from the left temporal lobe. Given the medically refractory seizures, it was recommended that the patient pursue a craniotomy for a selective amygdalohippocampectomy.

The patient undergoes an elective left craniotomy with selective amygdalohippocampectomy, with microdissection and neuronavigation.

On the claim, you would report:

• 61566 for the craniotomy
• +61781 (Stereotactic computer-assisted (navigational) procedure; cranial, intradural (List separately in addition to code for primary procedure)) for the neuronavigation
• +69990 (Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure)) for the surgical microscope use
• G93.81 (Temporal sclerosis) appended to 61566, +61781, and +69990 to represent the patient’s temporal sclerosis
• G40.219 (Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus) appended to 61566, +61781, and +69990 to represent the patient’s epilepsy

Brain FBR, Penetrating Wound Mean 61570, 61571

If the surgeon is performing craniectomy or craniotomy with a foreign body removal (FBR) from the brain, you’ll report 61570 (Craniectomy or craniotomy; with excision of foreign body from brain).The reason for this surgery will likely be from some sort of trauma that resulted in foreign material remaining in the brain, so diagnosis coding for these surgeries will vary.

If the surgery is for treatment of a penetrating wound of the brain (but without excision of a foreign body), you’d opt for 61571 (… with treatment of penetrating wound of brain).The difference between the two codes is that while 61570 accounts for the surgical approach and treatment of the wound with FBR, 61571 only accounts for surgical approach and wound treatment.

Example: A 22-year-old patient was involved in a violent altercation, resulting in a penetrating stab wound from a large hunting knife to the right parietal area. They did not lose consciousness. Examination reveals a right parietal scalp laceration, skull fracture, and leakage of cerebrospinal fluid. Imaging reveals a compound depressed fracture of the right parietal bone, a superficial cerebral contusion, and air in the brain substance. The neurosurgeon performs craniotomy with treatment of the penetrating wound of the brain including debridement, dural repair and elevation of the fracture.

On the claim, you would report 61571 for the craniotomy with S06.310 (Contusion and laceration of right cerebrum without loss of consciousness) appended.