Check Complexity, Brain Area on AVM Repairs
Remember to check for separately codeable services, too. When your neurosurgeon treats a patient with an arteriovenous malformation (AVM), you have your work cut out for you as a coder. This condition requires spot-on skills to identify with the proper ICD-10-CM code, and you must know whether an AVM is simple or complex before you can choose the correct procedure code. Check out this primer on ICD-10-CM coding for AVMs, as well as the CPT® procedures that your surgeon will use to treat the condition. Use These ICD-10 Codes for Brain AVMs Most common diagnosis errors occur by selecting the incorrect location of the AVM, misinterpreting the documentation, and lacking specificity. This can lead to an incorrect diagnosis code, which can result in inaccurate billing and reimbursement. When choosing a diagnosis code for AVM, you need to first direct your attention to the location. Once you have the location, then it is important to specify if the AVM is ruptured or not. If it is ruptured, you will be prompted for the specific location of the hemorrhage. There is also a branch off for traumatic hemorrhages where you have an opportunity to specify the specific site. For pediatric patients, there is also a newborn ruptured arteriovenous malformation code. Then, you’ll move on to choosing the proper CPT® procedure code if the surgeon decides to operate. A few of the diagnosis codes you’ll see for brain AVM include, but are not limited to: Best bet: As AVM codes are found throughout the ICD-10-CM code book, make sure you familiarize yourself with the sets containing cerebral AVM codes. Know What Intracranial AVM Surgery Looks Like Surgery for AVM patients consists of the physician resecting an AVM in the brain. This AVM is a tumor-like growth of blood vessels. After using angiography to locate the AVM, the physician performs a craniotomy in the affected area. The AVM is located and the blood vessels feeding the tumor are ligated. The tumor is resected, and bleeding is controlled. The bone flap is repositioned and secured; the scalp is re-anastomosed and sutured into layers. You will report the appropriate CPT® procedure code according to AVM location and ease of access. The location can be dural, infratentorial, supratentorial, within cavernous sinus, or other/unlisted. Then you’ll turn your attention to whether the procedure was simple or complex. You’ll report an AVM repair as simple unless there are complications or under certain circumstances that are noted in the medical record. The codes you’ll report for simple AVM repair are: AVM repair that is complex includes those that are larger than 3 cm, involve eloquent cortex, or require deep venous drainage. The CPT® codes for complex AVM are: If you have any doubt about whether an AVM repair is simple or complex, be sure to query the surgeon to avoid under- or overcoding the claim. Some defects may require a bone graft. In these cases, the donor site is already exposed for the primary procedure. The cranial bone graft harvested may be split or full-thickness, a shaving graft, or bone dust. When a full-thickness graft is required, the dura around the edge of the graft is exposed with a burr hole or neurosurgical craniotomy technique. A split graft requires removing lateral bone from a contoured area, which leaves it exposed, and an osteotome is correctly placed and tapped through to produce the bone graft. Shaving grafts are acquired and bone dust is produced by using a craniotome. The graft is then placed to repair the defect and reported in addition to the primary procedure. Placement of a bone graft for AVM repair is typically reported with +61316 (Incision and subcutaneous placement of cranial bone graft (List separately in addition to code for primary procedure)). Consider This Clinical Example A 2-month-old patient was admitted with headaches, seizures, and problems with hearing. Upon a full workup, MRI scans confirmed cerebral AVM, not currently ruptured. Although a rare case in a patient this age, the surgeon discussed the treatment option with the parents and decided to proceed with surgery to remove the cerebral AVM. Using stereotactic navigation, the surgeon performs an infratentorial craniotomy and locates an AVM greater than 3 cm. Due to the size of the AVM and the size of the patient, this is an extremely complex surgery that requires a separate pediatric surgeon to complete this operation. The AVM is successfully resected and the bleeding controlled. At this point, the surgeon performs a full-thickness cranial bone graft to rigidly fix and finish the repair of the defect. Finally, the scalp is re-anastomosed and sutured in layers. For this encounter, you’d report: Co-surgery note: Be sure to verify with the co-surgeon’s coder that the same CPT® and diagnosis codes are being billed to prevent denials. Kalie Bothma, CPC, CEDC, CSAF, Medical Coder, Corewell Health
