Neurosurgery Coding Alert

Complete reporting requires at least 4 codes over 2 operative sessions When your surgeon documents use of a cranial bone flap during cranioplasty, review the record carefully to determine if the surgeon temporarily placed the graft in a subcutaneous pocket for "safe keeping" during an earlier operative session.
 
If so, you should have reported an additional code for the initial placement - and you should be coding for the final retrieval and placement of the graft, as well. Part 1: Claim the Initial Placement You should select +61316 (Incision and subcutaneous placement of cranial bone graft [list separately in addition to code for primary procedure]) to describe temporary placement of a cranial bone graft into a distant subcutaneous site for future retrieval.
 
The surgeon may choose to call on 61316, for instance, following decompressive craniotomy, when immediate placement of the bone flap may aggravate intracranial hypertension from brain swelling, says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery. In this case, the surgeon creates a subcutaneous pocket in a suitable area, such as the abdominal wall, to store the cranial bone flap for later harvest and final placement. Don't Forget a Primary Procedure Because 61316 is an "add-on" code, you must be sure to claim a primary procedure to accompany it, says Tara L. Conklin, CPC, an instructor for CRN-Institute, a coding and reimbursement institution offering courses in reimbursement, medical billing, and outpatient and inpatient coding certification. "Certain surgical procedure codes are add-on codes that are always billed with another service. ... Payment will not be made for these add-on codes unless billed in addition to accompanying primary procedure," Medicare policy dictates.
 
Specifically, 61316 may accompany any of the following "access" procedures: 61304, 61312, 61313, 61322, 61323, 61340, 61570, 61571 or 61680-61705.
 
For example: The surgeon treats the patient in the operating room for evacuation of an intracranial hematoma (for instance, 61312, Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural). To minimize the rise in intracranial pressure due to swelling, the surgeon opts not to replace the cranial bone flap immediately. Instead, he creates a pocket in the abdominal wall and places the bone flap in the subcutaneous space for later use. In this case, you should report 61312 as the primary procedure and 61316 for creating the subcutaneous pocket for temporarily storing the graft. Part 2: Code Separately for Retrieval When the surgeon retrieves the cranial bone graft from the subcutaneous pocket at a later date, you should report +62148 (Incision and retrieval of subcutaneous cranial bone graft for cranioplasty [list separately in addition to code for primary procedure]).
 
Don't overcode: Code 62148 includes repair of the temporary placement site, Sandhusen says. Therefore, [...]