Neurosurgery Coding Alert

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.