KLS515
Contributor
I have a trauma case where the patient has severe facial fracture and anterior skull base defect with dural tears. I am using 62010 for the dura repair portion, wondering if modifier 22 would be appropriate to use since this is bilateral and multiple large tears. With the titanium mesh used in the repair of the skull base defect, is this included or is there another code to use for this? I also am stumped on the harvesting of the flap which was used by a Maxillofacial surgeon for his procedure. I understand "periosteal" to be the tissues around the bone, not actually a bone harvest.(?) This portion of the note reads:
The patient was repositioned for a supine position with three prong head
fixation. After prepping and draping in the usual sterile fashion,
bicoronal skin incision was made. A bifrontal periosteal flap was
harvested for later use. Bur holes were made. A bifrontal craniotomy was
performed. Large Gelfoam strips were placed over the superior sagittal
sinus with good hemostasis. After 40 cc of CSF drainage, satisfactory
brain relaxation was achieved. Gentle elevation in extradural fashion of
bilateral frontal lobes was performed and held in position with a
Greenberg retractor system. The posterior wall of the frontal sinus and the ethmoid bone were fractured and penetrated into the base of bilateral frontal lobe, resulting in large multiple dural tears. The anterior and posterior edges of dural tears were identified and closed with Duraguard graft. Significant
anterior skull base defect was repaired using a titanium mash. The
patient tolerated the entire procedure without any apparent complications.
Thanks for helping me out with my many questions!
The patient was repositioned for a supine position with three prong head
fixation. After prepping and draping in the usual sterile fashion,
bicoronal skin incision was made. A bifrontal periosteal flap was
harvested for later use. Bur holes were made. A bifrontal craniotomy was
performed. Large Gelfoam strips were placed over the superior sagittal
sinus with good hemostasis. After 40 cc of CSF drainage, satisfactory
brain relaxation was achieved. Gentle elevation in extradural fashion of
bilateral frontal lobes was performed and held in position with a
Greenberg retractor system. The posterior wall of the frontal sinus and the ethmoid bone were fractured and penetrated into the base of bilateral frontal lobe, resulting in large multiple dural tears. The anterior and posterior edges of dural tears were identified and closed with Duraguard graft. Significant
anterior skull base defect was repaired using a titanium mash. The
patient tolerated the entire procedure without any apparent complications.
Thanks for helping me out with my many questions!