Neurosurgery Coding Alert

Question: One of our patients has multiple complex cerebral aneurysms (5). Our neurosurgeon treated three of the five aneurysms which are described as "left-sided internal carotid artery aneurysms." He further documents that the operation involved "a left frontotemporal craniotomyfor clipping of left posterior communicating, left anterior choroidal and left carotid ophthalmic aneurysm." Should I report 61697 (Surgery of complex intracranial aneurysm, intracranial approach; carotid circulation) x 3 for this?

Answer: There are two ways to describe multiple aneurysm surgery. One option is to use modifier 59 (Distinct procedural service) to account for each additional aneurysm treated. The other option is to use the 22 modifier (Increased procedural services) on a single code and increase the fee.

The principle used to choose between the two methods involves single or multiple exposures. If the surgeon treats more than one aneurysm within the same microdissection exposure (eg anterior choroidal and posterior communicating artery aneurysms are very near one another), you would report with one aneurysm code and append modifier 22 to account for the extra work. If a significantly separate arachnoid exposure is required (likely the case in the carotid-ophthalmic aneurysm), then an additional aneurysm code with modifier 59 can be used.