Neurosurgery Coding Alert

Question: Our surgeon did the following procedure:

PREOPERATIVE DIAGNOSIS: Right forehead skull mass 1.5 cm in diameter.

PROCEDURE PERFORMED: Gross total resection 1.5 cm right frontal skull mass by neurosurgeon and plastics closure by plastic surgeon.

INDICATION FOR PROCEDURE: The patient is a 58-year-old woman who has a cosmetically significant growing right forehead mass. It measured approximately 1.5 cm in diameter. CT scan revealed calcified right forehead mass on the outer table. Mass was affixed to the skull. She wished to have it resected.

DESCRIPTION OF PROCEDURE: After being given general anesthesia the plastic surgeon prepped and draped the forehead. He performed plastics opening over the lesion. He removed the periosteum circumferentially from the lesion with periosteal elevators. Then the neurosurgeon used an osteotome to remove the lesion at the base from the anterior table of the skull. Furhter, the neurosurgeon used the Midas Rex drill to drill even where the calcified lesion was attached to the skull and obtained hemostasis with a Bovie knife. After irrigation with antibiotic solution, the specimen was sent as 1 piece to pathology for analysis. The plastic closure was done and there were no neurosurgical complications.

How would you code this? The plastic surgeon performed the incision and primary closure and they are billing 13131 (Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm).

Alaska Subscriber

Answer: The provided report uses the term "anterior table of the skull" rather than the terms "outer table" and "inner table," which would help determine the extent that the lesion extends into the skull. For benign tumors or lesions of the skull, you may consider using 61563 (Excision, intra and extracranial, benign tumor of cranial bone [eg, fibrous dysplasia]; without optic nerve decompression). If a craniectomy is performed to remove the lesion from the entire skull thickness, you may consider using 61500 (Craniectomy; with excision of tumor or other bone lesion of skull). If a routine closure is performed with the assistance of a plastic surgeon, this is considered a bundled service with the craniectomy codes and should be reported as a shared service with the 62 (Two surgeons...) co-surgery modifier. If a separately identifiable closure to manage the cosmetic consequence is required, the separate code reported by the plastic surgeon may be applicable.