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Wiki CPT Exploration for possible dural tear?

Thread starter fltbaroque
Start date Sep 8, 2020
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csf dural tear

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fltbaroque

Guru

Sep 8, 2020

How would you code? Patient is post-op decompression in which a dural tear was repaired. Patient continues to have increased pain and is suspected to have a CSF leak. Procedure is exploration only, finding no csf leak or additional tear. Doctor opened previous incision, explored down to the previous dural repair, irrigated, dried and closed the wound.
Would this be an unlisted code?

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