Neurosurgery Coding Alert

Question: The neurosurgeon repaired an intracranial arteriovenous (AV) malformation on a patient, and we reported 61697 -- only to receive a denial. Why did the insurer deny our claim? Aren't AV malformations considered complex aneurysms?

South Carolina Subscriber

Answer: An AV malformation is not the same as a complex aneurysm, which is why you received a denial for reporting 61697 (Surgery of complex intracranial aneurysm, intracranial approach; carotid circulation).
 
An AV malformation represents a variety of structurally abnormal blood vessel types. Some examples include arteriovenous malformation, capillary hemangioma and venous angioma.
 
In contrast, an aneurysm represents a weakening of an arterial blood vessel wall, resulting in a dilated outpouching from the weak-walled vessel, rendering it susceptible to rupture.
 
When your surgeon treats an AV malformation with excision, choose a code from the 61680-61692 code set, depending on the notes from the encounter.
 
So if the notes indicate that the neurosurgeon treated a simple supratentorial AV malformation, you-d report 61680 (Surgery of intracranial arteriovenous malformation; supratentorial, simple) for the service.