Neurosurgery Coding Alert

If you recognize separate sites, you could ethically earn more $$ on the claim Patients who visit your neurosurgeon for brain tumor excisions might require a subdural or intraparenchymal hematoma evacuation as well. Most of the time, however, you-ll select a single code to represent both procedures on the claim form.

On the other hand, there are also instances when you can report the hematoma evacuation separately, thereby gaining more rightful reimbursement for the treatment.

Check out this expert advice on when -- and when not -- to code for hematoma evacuation along with brain tumor excision. Don't Code Separately for Incidental Hematoma When the neurosurgeon performs most supratentorial brain tumor excisions, the correct code for the encounter is 61510 (Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma), says Teresa Thomas, RHIT, CPC, practice manager at St. John's Neurosurgery Clinic in Springfield, Mo.

(Note: For excision of meningiomas or tumors in other locations [other than the skull base], you would typically use either 61512, 61518, 61519 or 61520.)

During an excision, the surgeon may also have to perform hematoma evacuation. When she does this at the same site as the tumor excision, forget about reporting the evacuation separately, Thomas says.

Why? Any evacuation performed at the tumor site is incidental to the excision. Therefore, the Correct Coding Initiative (CCI) bundles evacuation (61312, Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural) into 61510.

-Evacuation of a hematoma at the site of a tumor excision would always be bundled, as the surgeon is -clearing the area- for more detailed work,- according to Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C.

Consider this example: A patient who has frequently complained of intense headaches and vomiting reports to the neurosurgeon saying that he had a seizure that morning. The surgeon performs a craniectomy and excises a supratentorial brain tumor. During the session, the surgeon also performs hematoma evacuation via the same craniectomy to remove some accumulated blood near the tumor site.

Because the neurosurgeon performed the evacuation and the excision at the same site, you should only report 61510 for the service.
 
Don't Forget 59 When Unbundling 61510, 61312 Although CCI bundles 61312 into 61510, the edit does have a -1- modifier, meaning you can report the codes separately on the same encounter form in some situations.

When? You can report both codes if the evacuation and excision are at separate sites and done through separate incisions, Thomas says.

On these claims, you-ll need to use modifier 59 (Distinct procedural service) to show the separate nature of the services. Also, don't forget to link diagnosis codes properly, Callaway says.

-In other words, link the hematoma diagnosis with the hematoma evacuation, and a [...]