Neurosurgery Coding Alert

Question: The physician performs a frontal ventriculostomy during an exploratory supratentorial craniotomy. The physician creates a separate burr hole contralaterally and an external ventricular drain (EVD) is inserted. Is the ventriculostomy included in the craniotomy procedure, or can I bill out for both procedures separately?

Colorado Subscriber

Answer: When the physician performs a ventriculostomy alongside a craniotomy, they have the option to either insert the EVD into the same site as the craniotomy or to create an entirely new opening. In this case, the physician is creating a burr hole via a separate site from the craniotomy. When two separate openings are created, you may bill out for both procedures.

For a frontal ventriculostomy, you will use code 61210 (Burr hole[s]; for implanting ventricular catheter, reservoir, EEG electrode[s], pressure recording device, or other cerebral monitoring device [separate procedure]). When checking the National Correct Coding Initiative (NCCI) edits with the craniotomy code 61304 (Craniectomy or craniotomy, exploratory; supratentorial), you will see that 61210 is a column 2 code for 61304. Since there are two separate openings, the coder can apply modifier 59 (Distinct procedural service) to the column 2 code 61210. If the surgeon performs the ventriculostomy at the same site of the craniectomy, you may not bill separately for 61210.

Remember to submit justification to the insurance company when you opt to use modifier 59. This justification should come in the form of a written note, preferably by the physician, explaining that the ventriculostomy site is separate from that of the craniotomy.