Neurosurgery Coding Alert

Warning: Watch out for craniotomy/cranioplasty bundles When reporting cranial reconstructions, you must remember that not all cranioplasty codes (62140-62147) require that the surgeon place a bone graft. In fact, even when the surgeon does use a graft, you cannot assume a cranioplasty code is the right choice. Let our experts give you a one-at-a-time tour of the cranioplasty codes, and you-ll easily handle the next cranial reconstruction claim to cross your desk. No Grafts? No Problem If your surgeon performs cranial reconstruction without placing bone grafts -- specifically for repair of skull defect -- you should look first to 62140 (Cranioplasty for skull defect; up to 5 cm diameter) and 62141 (- larger than 5 cm diameter), depending on the defect's size, says Darlene Boschert,-CPC, CPC-H, CCP, CMM, CHCO, CMT, CMA, director/instructor of the Allied Health Programs for the Career Institute of Florida in St. Petersburg. Such a repair may be necessary due to congenital defect, for instance, or to repair the skull following an excision procedure. Don't be misled: Although 62140 and 62141 do not include autograft, they may include use of prosthetics, such as titanium mini-plates, to re-attach bone. Note, in addition, that the cranioplasty codes do not describe routine closures following craniectomy or craniotomy. Rather, you should reserve 62140-62141 only for those cases when the surgeon reconstructs or replaces a skull defect because of damage, excision or other reasons. Check CCI before coding: In many cases, you will not report cranioplasty (62140 or 62141) separately, even when your surgeon has documented the procedure. The national Correct Coding Initiative (CCI) bundles cranioplasty codes 62140 and 62141 to almost every code from the craniotomy or craniectomy section (61304-61571). With few exceptions, you cannot override the edits using a modifier. Therefore, if your surgeon must repair a skull defect(s) as described by 62140 or 62141 during a craniectomy/craniotomy as described by 61304-61571, you should consult CCI before reporting the repair separately -- or expecting separate reimbursement -- for Medicare carriers or other payers that follow CCI guidelines. Make it easy: View the sidebar on page 27 for a complete list of codes to which CCI bundles 62140 and 62141. Example: A surgeon performs a craniectomy to remove two meningiomas in different portions of the brain (supratentorial and infratentorial), followed by secondary repair of the dura with repair and reconstruction of a 7-cm defect of the skull base. In this case, says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, your claim should include: - 61512 -- Craniectomy, trephination, bone flap craniotomy; for excision of meningioma, supratentorial - 61519 -- Craniectomy for excision of brain tumor, infratentorial or posterior fossa; meningioma - [...]