Neurosurgery Coding Alert

Hint: Turn to 62000 for simple fractures.

You read in the op report that your neurosurgeon performed surgical repair of a depressed skull fracture in a patient with an open fracture of the skull. But, if you don’t check the medical documentation carefully to see what type of fracture the surgeon repaired and whether he performed debridement or dural repair, you could be setting up your claim for failure.

Read on to learn more.

Tip 1: Follow This Guidance for Simple Fractures

If your neurosurgeon performs surgical management of a depressed skull fracture, he will make an incision in the scalp, gain access to the skull fracture, maneuver the broken bones to reassemble them, and fix the bones using sutures, screws, and plates. To keep the original shape of the skull, your neurosurgeon may use metallic mesh or bone cement.

Simple skull fractures are one type that you may encounter in your neurosurgery practice. When your surgeon repairs a simple skull fracture, you should report code 62000 (Elevation of depressed skull fracture; simple, extradural).

As you can see, the code descriptor for 62000 specifies that the code is for simple depressed fractures. The term “simple” implies a closed fracture. So, you should report 62000 when you confirm in the operative note that there was no laceration or wound in the scalp region overlying the skull fracture, and that the neurosurgeon did not perform dural repair.

Don’t forget: In the operative note for a depressed skull fracture, you must confirm elevation of the skull fracture when you read that your surgeon elevated any piece(s) of bone that had been pressed inwards and repositioned them to their correct position. If necessary, your neurosurgeon may use a metal wire or plates to maintain the elevated piece(s) of the skull fracture. Your neurosurgeon may then close the skin with stitches or staples.

Tip 2: Rely on This Expertise for Compound or Comminuted Fractures

On the other hand, when you read in the op note that your neurosurgeon stabilized and repositioned a compound or comminuted depressed skull fracture, you should report 62005 (Elevation of depressed skull fracture; compound or comminuted, extradural).

Compound fractures defined: Typically, compound skull fractures are associated with open scalp wounds. The term compound refers to the open wound with communication of the fracture site to the skin surface.

Comminuted fractures defined: Comminuted skull fractures imply that the fracture resulted in multiple fragments of the skull. Comminuted fractures may or may not be associated with open scalp wounds.

Coding example: The neurosurgeon performed an elevation of a compound, comminuted, depressed skull fracture and performed did methyl methacrylate cement cranioplasty to repair the gap left from bone fragments too small to replace. You should report 62005 for this service.

Tip 3: Always Check Op Report for Debridement and Dural Repair

Whenever your neurosurgeon repairs a simple, compound, or comminuted depressed fracture of the skull, you should also confirm whether the neurosurgeon did any repair of the dura. Additionally, you need to check if your surgeon also debrided any of the devitalized brain tissue.

You should report 62010 (Elevation of depressed skull fracture; with repair of dura and/or debridement of brain) for repair and/or debridement. This code is inclusive of any dural repair and/or debridement when done with an elevation of depressed skull fracture.