Read these two neurosurgery coding scenarios and know what CPT codes you should apply while ealing with such situations.|
Check Extension in Extramedullary Tumors
Question: How do you report a suboccipital craniectomy and C1-3 laminectomy for removal of intradural extramedullary tumor?
Answer: Even though a far lateral transcondylar skull base approach with resection of upper cervical segments for access is reported with skull base approach as well as definitive procedure codes, the brief description delivered implies a direct posterior approach. There is no single code present that describes suboccipital craniectomy as well as cervical laminectomy meant for resection of a presumably craniovertebral junction meningioma.
In case the tumor was mainly spinal, then you would report code 63280 once you execute CPT lookup (Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, cervical), perhaps appended with 22 (Increased Procedural Services) modifier in case a significant craniectomy is carried out for junctional exposure.
In case the tumor extended considerably intracranially and also intraspinally, then one would report code 61519 (Craniectomy for excision of brain tumor, infratentorial or posterior fossa; meningioma) and 63280 (Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, cervical) -51 (Multiple procedures) after you execute CPT lookup . In case the operating microscope was used for microdissection, one could furthermore report CPT code 69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]).
Report Technique as well as Anastomosis for Moyamoya
Question: What CPT code would be suitable for frontal craniotomy for synangiosis once the diagnosis is moyamoya?
Answer: There are two sorts of synangiosis carried out for moyamoya disease. One can carry out an encephaloduroateriorsynangiosis (EDAS) in which a superficial temporal artery is secured in line with the cortical surface or an encephalomyosynagnosis (EMS) in which temporalis muscle is secured to the cortical surface. Both procedures would be reported with the unlisted CPT code 64999 (Unlisted procedure, nervous system). Another procedure carried out for moyamoya disease, superficial temporal artery-middle cerebral artery (STA-MCA) bypass would be reported with CPT codes 61711 (Anastomosis, arterial, extracranial-intracranial [eg, middle cerebral/cortical] arteries) as far as bypass is concerned and 69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) as far as utilization of an operating microscope is concerned.
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