Neurosurgery Coding Alert

Question: What is the CPT^® code for a cranioplasty for a craniotomy defect with a bone graft using bone obtained from the bone bank?

Colorado Subscriber

Answer: For a cranioplasty for a craniotomy defect, you will immediately want to look toward codes 62140 (Cranioplasty for skull defect; up to 5 cm diameter) or 62141 (Cranioplasty for skull defect; larger than 5 cm diameter).

However, if the surgeon performs a bone graft using bone taken from the patient (autograft), then you will select either 62146 (Cranioplasty with autograft [includes obtaining bone grafts]; up to 5 cm diameter) or 62147 (Cranioplasty with autograft [includes obtaining bone grafts]; larger than 5 cm diameter). For either of these sets of codes, you will want to make sure the provider documents the diameter of the cranioplasty before making a determination.

Since the surgeon is using bone from a bone bank rather than from the patient’s body, codes 62146 and 62147 will not be applicable. While there is no reference to an allograft in the code description, the code’s clinical responsibility states that the surgeon “replaces the bone flap and fixes it in place using plates, screws, or bone graft to cover the defect.” This is enough to conclude that codes 62140 and 62141 include the work performed in application of an allograft.