Neurosurgery Coding Alert

Grafting hints at a separate code If you assume repair of the dura is an unreportable service with all cranial and spinal procedures, your surgeon may be missing out on legitimate reimbursement opportunities. Take our experts- advice, and learn when dural repair is, indeed, a separately reportable service. Don't Treat All Dural Repairs Equally Generally, you cannot report additional codes for closing a surgical wound or for routine complications that arise as a result of surgery. Because the surgeon must cut through the dura -- the tough, outer layer of the meninges, surrounding the brain and spinal cord, that contains the cerebrospinal fluid -- to gain access to the brain or spinal nerves, repair of the dura upon closing the surgical wound is a common component of many procedures, says Annette Grady, CPC, CPC-H, CPC-P, CCS-P, compliance auditor at The Coding Network. For example: The surgeon performs a right parietal craniotomy with gross total resection of a meningioma, followed by closing with simple dural repair. In this case, you may report 61512 (Craniectomy, trephination, bone flap craniotomy; for excision of meningioma, supratentorial) for the craniectomy and meningioma excision. Standard coding practice dictates that 61512 includes closure with repair of the dura. What to watch for: If the surgeon needs a graft harvest to repair a defect left after the craniotomy, you may report a graft harvest code separately if the surgeon obtains the graft from a site other than the local exposure. When repair of the dura constitutes the primary procedure -- whether or not the repair requires a separate graft -- you will also generally report the repair separately. For Spinal Repairs, Look to 63707-63710 When the surgeon must repair a cerebrospinal fluid leak due to dural injury, you should call on either 63707 (Repair of dural/cerebrospinal fluid leak, not requiring laminectomy) or, if the repair requires laminectomy, 63709 (Repair of dural/cerebrospinal fluid leak or pseudo-meningocele, with laminectomy). The surgeon may have to perform laminectomy for dural repair, for instance, when he must approach a leak from above or below the level of a prior surgery or, more commonly, during an initial open approach to repair dura after a complication of a percutaneous spinal procedure. In each case, the surgeon may place a graft over the damaged area of the dura and suture it in place. Codes 63707 and 63709 include all components of the surgery, including approach, repair and closure. Code 63710 (Dural graft, spinal), in contrast, describes placing a dural graft (most commonly synthetic dura substitute or bovine pericardium) for repair of the dura, over the spine only (the code cannot apply to cranial procedures). Because 63710 does not include the spinal approach and closure, you should [...]