Neurosurgery Coding Alert

Question: How do you code a traumatic dural repair? This dural tear is not iatrogenic. Can we also submit code for the microscope separately?

Alaska Subscriber

Answer: If the dural tear is intracranial, it is most likely associated with a fracture and you may consider the fracture treatment codes. Only CPT^® 62010 (Elevation of depressed skull fracture; with repair of dura and/or debridement of brain) and 62100 (Craniotomy for repair of dural/cerebrospinal fluid leak, including surgery for rhinorrhea/otorrhea) describe the work of dural repair. CPT^® +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) for microdissection technique may be concurrently reported if performed.

For spinal dural repair, there are specific codes for the spine, but these are typically associated with prior iatrogenic dural tears (but not required to be). If a traumatic spinal dural tear is repaired, you may consider the following three codes:

• 63707, Repair of dural/cerebrospinal fluid leak, not requiring laminectomy
• 63709, Repair of dural/cerebrospinal fluid leak or pseudomeningocele, with laminectomy
• 63710, Dural graft, spinal.

Note: You do not submit these codes when your surgeon does a dural repair for incidental small dural lacerations or leaks that may happen during the intraoperative course of another operation.

Additionally, if your surgeon is performing an intradural procedure, say for example, resection of an intradural spinal tumor, you cannot submit these dura repair codes.

In these procedures, dura repair is bundled into the primary procedure and you cannot report it separately.

Repair may be part of ORIF: Dural repair can be part of some procedure like fracture repair. Look for these in the operative note. An open reduction and internal fixation (ORIF) code, 22325-22327 could be appropriately submitted if your surgeon did any fracture reduction, decompression of fractured bony elements, and internal fixation of a fracture. In the case of using an ORIF code, you cannot submit dural repair code, for example 63709 as the ORIF codes entail performing a laminectomy.

Check for laminectomy: To pick up the most appropriate code, from 63707, 63709, and 63710, check if your surgeon did a laminectomy to complete the repair. The code 63707 indicates a repair without a laminectomy and 63709 indicating a repair with a laminectomy. You submit code 63710 when your surgeon positions a dural graft as part of the repair.

Bill for microdissection: The microscope and microdissection (+69990) are not included in codes 63707, 63709, and 63710. You may bill for microdissection, where appropriate.