Neurosurgery Coding Alert

Question: The surgeon performed a craniotomy to treat two aneurysms, one ruptured and one non-ruptured. Should I report one or two units of 61700?

Pennsylvania Subscriber

Answer: In most cases, if the surgeon can remove the second aneurysm via the same craniotomy, you cannot report a separate code. Rather, you would report 61700 (Surgery of simple intracranial aneurysm, intracranial approach; carotid circulation) only once to report removal of both aneurysms.
 
You may also have some success reporting two units of 61700 (or 61702) if the surgeon removes two aneurysms from separate anatomic locations through a single, enlarged craniotomy.
 
Without an absolute rule to cover all possibilities, you should use common sense when deciding to use a single code, perhaps with modifier -22 (Unusual procedural services) to reflect the surgeon's treatment of multiple aneurysms, or separate codes with modifier -59 (Distinct procedural service) (and possibly modifier -52 [Reduced services] to indicate that the surgeon didn't perform a second craniotomy).
 
In either case, your supporting documentation should make clear to the payer the unusual nature of the surgery and that the aneurysms occurred in distinct, separate locations.
 
If the surgeon must perform temporary vessel occlusion or trapping to repair an aneurysm (more commonly done in ruptured aneurysms), the surgery qualifies as a "complex" repair, which you should report using 61697-61698, as appropriate. If the surgeon attends to a complex aneurysm and a simple aneurysm during the same surgery - even via the same craniotomy - you may report each procedure separately.
 
For example, the surgeon performs a craniotomy and clips a large anterior communicating artery aneurysm measuring 17 mm. Further retraction of the temporal lobe and posterior exploration reveals a smaller aneurysm at the posterior communicating artery (PCA), which the surgeon also treats. Report 61697 for the anterior artery and 61700-59-52 for the PCA aneurysm.