Neurosurgery Coding Alert

Remember to include repair size on claim.

Some code sets are specific to certain conditions, and one of those conditions is meningocele/myelomeningocele. These two congenital conditions are similar, though not identical.

Repairs for these defects boils down to four codes: Master their intricacies and your meningocele/myelomeningocele coding will only improve.

Check out this primer on meningoceles, myelomeningoceles, and the codes that represent them.

Use 63700 for ‘Small’ Meningocele

You’ll report meningocele repair with either 63700 (Repair of meningocele; less than 5 cm diameter) or 63702 (… larger than 5 cm diameter).

What is it? Meningocele is a type of neural tube defect where a sac-like protrusion containing meninges (protective membranes surrounding the brain and spinal cord) and cerebrospinal fluid forms through an opening in the vertebral column. (This protrusion does not contain any neural tissue, which differentiates it from myelomeningocele).

Meningocele can occur in the cervical, thoracic, or lumbar regions of the spine, but it is most commonly found in the lower back region. Consider this example from Gregory Przybylski, MD, Chairman of Neuroscience at the New Jersey Neuroscience Institute, JFK University Medical Center in Edison, New Jersey.

Example: An infant is born with a mass on the lower back that is noticed by their mother and pediatrician. A neurosurgeon is consulted and on examining the infant observes a translucent protuberance over the low back covered with skin that appears to contain fluid. The sac measures 4 cm in largest diameter. The infant appears to be moving their lower limbs normally. Lumbar magnetic resonance imaging (MRI) reveals a lumbar meningocele, with no extension of neural elements into the sac. Brain MRI does not show hydrocephalus. There does not appear to be any cord tethering. The neurosurgeon recommends repair of the meningocele.

Several days later, the neurosurgeon performed the excision of the meningocele and closure of the 4 cm defect.

For this encounter, you’d report 63700 for repair of the defect with Q05.7 (Lumbar spina bifida without hydrocephalus) appended to represent the lumbar meningocele.

Neural Tissue Involvement Means Myelomeningocele

You’ll report myelomeningocele with either 63704 (Repair of myelomeningocele; less than 5 cm diameter) or 63706 (… larger than 5 cm diameter).

What is it? Myelomeningocele is severe; in this neural tube defect, the spinal cord and meninges protrude through an opening in the vertebral column. This creates a sac-like structure containing both neural tissue and cerebrospinal fluid.

Myelomeningocele is the most severe form of spina bifida and can result in various neurological issues, such as muscle weakness, paralysis, and loss of sensation below the level of the defect. Consider this example, also from Przybylski.

Example: An infant is born with an open defect on the lower back, draining cerebrospinal fluid that is noticed by the pediatrician. A neurosurgeon is consulted and on examining the infant observes an open defect with neural plaque and draining cerebrospinal fluid. The defect measures 5.5 cm in largest diameter. The infant appears to have limitation in foot movement. Lumbar MRI reveals a lumbar myelomeningocele, with extension of neural elements into the defect. Brain MRI does not show hydrocephalus. The spinal cord is tethered to the defect. The neurosurgeon recommends urgent repair of the myelomeningocele, which is performed that day.

The neurosurgeon performs microdissection of the neural elements, de-tethering of the spinal cord, and closure of the 5.5 cm defect.

For this encounter, you’d report 63706 for the repair and +69990 for the microdissection. Append Q05.7 to 63706 and 69990 to represent the myelomeningocele.

Note: ICD-10 does not differentiate between a meningocele and a myelomeningocele, despite the significant clinical differences between the two conditions.