Neurosurgery Coding Alert

Question: What is the correct CPT® code for a revision of craniectomy? The patient had a previous surgery for a brain tumor and presented with progressive occipital neuralgia associated with the trigger point area and due to a protruding mesh cranioplasty defect..

New Mexico Subscriber

Answer: This brief vignette describes a revision of a previously performed cranioplasty because of mesh protrusion and symptoms of occipital neuralgia. The repair codes include a variety of cranioplasty options, but none specifically indicate a revision cranioplasty. While reporting CPT® 62143 (Replacement of bone flap or prosthetic plate of skull) may be appropriate, this vignette may involve a revision rather than replacement, depending on how the protruding mesh is handled. Alternatively, if a replacement is not actually performed, unlisted code 64999 (Unlisted procedure, nervous system) may be more appropriate to report the work performed.