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Old 06-24-2010, 08:03 AM
ckirkp1 ckirkp1 is offline
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Default Neurosurgery

Can I code for both a craniotomy w/ biopsy of a tumor and evacuation of tumor cyst? It was done at the same surgical session. I know that I can use code 61304 for the craniotomy w/ biopsy but can I use an additional code with this and if I can't what code will best fit this description. Any help is appreciated.
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Old 06-24-2010, 08:38 AM
RebeccaWoodward* RebeccaWoodward* is offline
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Per NCCI edits:

2. Biopsies performed in the course of Central Nervous System (CNS) surgery should not be reported as separate procedures.

3. Craniotomies and craniectomies always include a general exploration of the accessible field. An exploratory craniectomy or craniotomy (CPT code 61304 or 61305) should not be reported separately with another craniectomy/craniotomy procedure performed at the same anatomic site and same patient encounter.

Very doubtful that you can report the BX. Is there anyway to post the op note in order to have a little more information about what was actually done during the procedure?
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Old 06-24-2010, 09:19 AM
ckirkp1 ckirkp1 is offline
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Here is the description of the op note. Thanks soooo much for your help.

A frontoparietal craniotomy was performed. Scalp flap was reflected forward. Temporalis fasica was then incised. At the same respective location 2 bur holes were then placed and osteoplastic frontotemporal craniotomy was then elevated. Dura was opened anteriorly and the dural flap was reflected inferiorly. Brain was herniating thru the dural opening. The sulcus was then opened and in the anterior aspect of this cystic tumor was then opened thru small incision. Immediately tumor fluid escaped and almost entirely a tumor tissue thinned out over the cyst. A sm thumb nail size plug of tumor involved cortex was then removed and sent to pathology. The cortex posterior to that biopsy site was now completely sunken as the cyst is evacuated. Pathologist reports that the findings are consistent with a glioblastoma multiforme.
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Old 06-24-2010, 11:54 AM
RebeccaWoodward* RebeccaWoodward* is offline
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Was there any mention that the bone flap was replaced? Or is this the entire report?

61510-The physician removes a flap of bone from the skull to access and remove a brain tumor located underneath. The flap of bone is removed with the help of a hand-operated drill.

Generally speaking, the terms craniotomy and craniectomy are used interchangeably within the CPT book. Whenever the code descriptor includes the terminology "craniotomy or craniectomy" the associated code may be used regardless of whether a craniotomy or craniectomy was performed.

In large part, the difference in terminology generally reflects how the part of the cranium that was removed in order to gain access to inside the skull is treated upon completion of the procedure. In a craniectomy, portions of the skull or bone flap used to gain access to the inside of the cranium are permanently removed and is not returned to the patient's body upon completion of the procedure. Conversely, when the term craniotomy is used, it usually describes a procedure where the bone flap is returned to its normal position prior to closure.

This is why I asked about the flap.

A craniectomy or craniotomy also can be used to find and remove a brain tumor. In general the scalp incisions, bone openings and exposures of the brain tend to be larger than necessary to ensure that the surgeon can actually find the brain tumor within the craniotomy opening.

CPT codes 61510 and 61518 report different types of tumors other than a meninigioma. This may include benign brain tumors such as epidermoid tumors, dermoid tumors, hemangioblastomas, colloid cysts, subependymal giant cell astrocytomas, and pleomorphic xanthoastrocytomas. Malignant tumor can be either primary or secondary sites. A primary malignant brain tumor starts from cells in the brain. When related to the nervous system, they often are called gliomas .

I would probably query your physician a little more since I really don't think 61304 reports the work involved.
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Old 06-24-2010, 12:30 PM
ckirkp1 ckirkp1 is offline
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The bone flap was returned to its normal position.

Thanks for the help. I know I couldn't use the 61304 only because more work was involved then just exploratory. I just didn't know if I can use the 61304 with the 61510 becaue he did a biospy along with the evacuation of the tumor cyst. He took a biopsy of the tumor and at the same time did an evacuation of the cyst in the same spot. In his notes he has it as a tumor cyst.

I didn't want to under code but then again I don't want to code more than necessary. So can I use both codes or just use the one???
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Old 06-24-2010, 02:16 PM
RebeccaWoodward* RebeccaWoodward* is offline
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I would code 61510 if the entire report supports this procedure. The exploration would be inclusive.
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