Neurosurgery Coding Alert

Question: Our neurosurgeon performed a 62120 service. Can you explain what steps he adopted to repair the encephalocele so I can better understand the procedure?

Montana Subscriber

Answer: When performing a 62120 (Repair of encephalocele, skull vault, including cranioplasty) service, the surgeon will take the following steps to repair the encephalocele.

Step 1: Incision: The surgeon makes an incision in the patient’s scalp to expose the area around the cerebral herniation. Then, the surgeon separates the protruding cerebral tissue from the scalp tissue, taking care to minimize blood loss and avoid damaging the herniated brain tissue.

Step 2: Burr hole: With the use of a surgical drill, the surgeon may make one or more burr holes and insert a craniotome to raise a bone flap and gain better access to the patient’s brain and dural margins.

Step 3: Removal of cerebral tissue: The surgeon then carefully removes any nonfunctional cerebral tissue and returns the brain tissue and any membranes or fluids that have come out of the gap in the skull back into the skull.

Step 4: Repair of encephalocele: The surgeon removes the sac that surrounded the encephalocele and closes the damaged dura with sutures and graft material.

Step 5: Closure: The surgeon may apply a synthetic graft with or without a tissue sealant, such as fibrin glue, over the dural suture line to help close the dural defect and create a watertight seal; replacement of the bone flap and/or placement of a cranioplasty to close the skull and finally suture closure of the scalp is performed. 

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