Neurosurgery Coding Alert

Question: Our neurosurgeon initiated an endoscopic removal of the intraventricular colloid cyst and converted it to a craniotomy to arrest the excessive bleeding during the procedure. Can we report this as an endoscopic procedure, an open procedure, or both? Please help.

New York Subscriber

Answer: You can report code 62162 (Neuroendoscopy, intracranial; with fenestration or excision of colloid cyst, including placement of external ventricular catheter for drainage) for the endoscopic intraventricular cyst removal if the procedure is completed. In your description of the procedure, the surgeon converts an endoscopic approach to open procedure as there was excessive bleeding. In this case, you report code 61516 (Craniectomy, trephination, bone flap craniotomy, for excision or fenestration of cyst, supratentorial). You may include documentation for the extra work and effort provided in converting from an endoscopic to open approach to justify for the additional payment with modifier 22 (Unusual procedural services).