Neurosurgery Coding Alert

Adopt a systematic approach to define each step that your surgeon does. Below is a listing of codes for the operative note examples.

Codes for operative note 1:

• You should submit code 61583 (Craniofacial approach to anterior cranial fossa; intradural, including unilateral or bilateral craniotomy, elevation or resection of frontal lobe, osteotomy of base of anterior cranial fossa). 

• For the dural tumor removal and repair, you submit code 61601 (Resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; intradural, including dural repair, with or without graft). 

• For the grafts, you should submit discrete codes. If your surgeon removed the fascia lata graft with stripper, you will turn to code 20920 (Fascia lata graft; by stripper). The pericranial graft would be considered a local autograft, and you will not report this separately.

• If however, your surgeon placed a spinal drain at the time of surgery, this would be separately reportable as 62272 (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid [by needle or catheter]). 

 “While this tumor had both intradural and extradural components that required a dural incision as well as ethmoidectomy for removal of the intradural and extradural components reqpectively, only a single most definitive approach code may be reported. Since intradural as well as extradural work was performed, the best choice to report the approach was CPT® 61583,” Przybylski says.

Codes for operative note 2: 

This operative note describes an orbitocranial procedure. You report code 61586 (Bicoronal, transzygomatic and/or Lefort 1 osteotomy approach to anterior cranial fossa with or without internal fixation, without bone graft) for the approach component. The portions of this approach include: 

• Bifrontal supraorbital osteotomy

• Subfrontal extradural and intradural access 

• No orbital exoneration (Your surgeon removes only the eyebrow bone and possibly the superior portion of the orbit.

You may also submit code 61601 for the intradural removal. 

“Similar to the previous case, the tumor excised has both intradural and extradural components,” Przybylski says. The definitive approach code chose should therefore be the intradural form. It should be noted in both cases that the dural repair is considered part of the definitive procedure. The secondary repair codes 61618 and 61619 are reported for a subsequent repair for post-operative CSF leak after the index procedure.