Neurosurgery Coding Alert

Question: The surgeon performed a transnasal endoscopic approach and resection of a pituitary tumor, then repaired a cerebrospinal fluid leak with an abdominal fat graft and pedicle vascularized nasal septal flap. How should we code the procedure? Washington Subscriber Answer: Begin with two codes: • 62165 -- Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or transspenoidal approach • 20926 -- Tissue grafts, other (e.g., paratenon, fat, dermis). CSF catch: Because the surgeon corrected the cerebrospinal fluid (CSF) leak during the primary procedure, you won't report it separately. If the repair was secondary, however (such as when the surgeon repaired the leak after a previous skull-base procedure) you would report 61619 (Secondary repair of dura fore cerebrospinal fluid leak, anterior, middle or posterior cranial fossa following surgery of the skull base; by local or regionalized vascularized pedicle flap or myocutaneous flap [including galea, temporalis, frontalis or occipitalis muscle]).