Neurosurgery Coding Alert

Question: The surgeon performed frontal craniotomies on both the left and right sides to evacuate subdural hematomas. Can I report 61312-50 for this, or is there a better solution?


Texas Subscriber


Answer: You should not report modifier 50 (Bilateral procedure) with 61312 (Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural), according to the Medicare Physician Fee Schedule database. The database includes a -0- modifier indicator in the -BILAT SURG- column for 61312, which indicates that you cannot use modifier 50 to report a bilateral procedure with this code.

Instead, if the surgeon truly performed frontal craniotomy at two locations on either side of the skull, you should report 61312 and a second unit of 61312 with modifier 59 (Distinct procedural service) appended. Modifier 59 on the second unit of 61312 tells the payer that the second craniotomy occurred at a separate anatomic location than the first craniotomy.

To further differentiate the craniotomies, you may also append modifiers LT (Left side) and RT (Right side). Be sure to have on hand supporting documentation that justifies your coding by noting the existence of two separate hematomas and the two separate approaches necessary to treat them.