Neurosurgery Coding Alert

Cranioplasty, bone grafts guide you to the right code.

When your surgeon performs reduction services for a craniomegalic skull, you'll be in good shape if you can identify in the op note any cranioplasty or craniotomy work your surgeon did. And knowing when to report any bone grafts will also come in handy. See the advice that follows for accurately capturing all craniomegalic skull reduction services.

Confirm the Cranioplasty

When reducing a craniomegalic skull, your surgeon may simply manipulate and maneuver the bones to appropriately position them. In this case, your surgeon neither does a cranioplasty nor uses any bone grafts for repair. When your operative note specifies no cranioplasty or bone grafts, you report code 62115 (Reduction of craniomegalic skull [eg, treated hydrocephalus]; not requiring bone grafts or cranioplasty) for the reduction your surgeon performed. Your surgeon essentially tries to improve the skull symmetry by remolding the skull bones. "These uncommon procedures are typically performed in children who had late treatment of hydrocephalus, resulting in disproportionate size of the head," says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Your surgeon may need to do a cranioplasty during reduction of a craniomegalic skull, usng either bone tissue or synthetic materials to replace a portion of the skull. For simple cranioplasties during the procedure, you would report code 62116 (Reduction of craniomegalic skull [eg, treated hydrocephalus]; with simple cranioplasty).

Example: If you read in the operative note that your surgeon used synthetic material like titanium plate, acrylic, silastic, tantalum, or other synthetic bone substitutes, and then secured these in place with special discs, screws, or plates, you confirm that your surgeon did a cranioplasty. In this case, you report code 62116. "While this procedure does not preclude use of bone graft, skull reductions performed with bone grafts are typically reported with 62117 (Reduction of craniomegalic skull [eg, treated hydrocephalus]; requiring craniotomy and reconstruction with or without bone graft [includes obtaining grafts])," says Przybylski.

Do Not Separately Report Bone Grafts

When attempting to reduce a craniomegalic skull, your surgeon may expose the skull, make one or more small burr holes, and then insert a special saw through the burr hole. Your surgeon will then use a craniotome to cut an outline of the bone flap (Figure 1). In this case, you confirm your surgeon does a craniotomy and report code 62117. You will read further that your surgeon will close the craniotomy and may or may not bone grafts in this procedure.

Tip: You do not separately report for the procuring of bone grafts, when bone grafts are used in the procedure of craniotomy and reconstruction, as the code 62117 is inclusive of the same. "Code 62117 is valued highest among the skull reduction procedures, because it includes the more extensive procedures as well as bone graft harvesting, if performed, says Przybylski.

Example: Your surgeon may attempt to reduce the size of a very large skull using craniotomy. "A child with persistent enlargement of the frontal skull secondary to hydrocephalus despite shunting needs to undergo a reductive craniotomy," says Przybylski. "A bicoronal incision is made to allow access for a bifrontal craniotomy. The craniotomy flap is bisected and portions of both flaps are resected to allow for reduction is size of the forehead. The segments are reassembled and secured to each other as well as to the skull defect with mini-plates and screw fixation."