Neurosurgery Coding Alert

Question: Our surgeon performed a computed tomography (CT) guided stereotactic brain biopsy. A few hours after the surgery the patient developed a hematoma. The surgeon performed a craniotomy for evacuation of the hematoma and debulked the tumor. How should I code this? Is the tumor debulking included in the craniotomy? New York Subscriber Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Answer: Report 61510 (Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma) with modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) appended for the return session to the operative room. Although not a staged procedure, Medicare considers this a more extensive procedure than the biopsy, which is another allowable use of modifier -58.

You may not report the hematoma evacuation separately, although if it adds significant extra effort you may append modifier -22 (Unusual procedural services) to 61510. If the neurosurgeon performs only hematoma drainage, however, 61312 (Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural) with modifier -78 (Return to the operating room for a related procedure during the postoperative period) is appropriate.