Neurosurgery Coding Alert

Neurosurgery Coding:

Know How Surgeon Created Hole for Drain Placement Coding Success

Question: Encounter notes indicate that the surgeon “created Burr hole/placed EVD via Burr Hole to reduce icp.” Can you tell me how to decipher this note, and how to code what they are describing?

Iowa Subscriber

Answer: Your surgeon performed an external ventricular drain (EVD) insertion to reduce intracranial pressure (ICP). You should report this service with 61210 (Burr hole(s); for implanting ventricular catheter, reservoir, EEG electrode(s), pressure recording device, or other cerebral monitoring device (separate procedure)).

Increased intracranial pressure highlighted in red on left frontal brain region illustrating headache and neurological compression symptoms

Note: The surgeon might also perform the EVD using a twist drill to create the opening. When this occurs, report 61107 (Twist drill hole(s) for subdural, intracerebral, or ventricular puncture; for implanting ventricular catheter, pressure recording device, or other intracerebral monitoring device).

Neurosurgeons perform EVD for patients with traumatic brain injury (TBI) or other neurological conditions, who can develop increased ICP due to brain swelling or intracranial bleeding. An EVD can help manage this complication, said Leigh Poland, RHIA, CCS, CDIP, CIC, AHIMA Approved ICD-10-CM/PCS Trainer, vice president of the Coding Services Line at AGS Health.

During her HEALTHCON 2026 presentation “Trauma Coding Mastery,” Poland explained that an EVD allows for:

  • Monitoring of ICP
  • Drainage of cerebrospinal fluid (CSF) to reduce pressure
  • Treatment of hydrocephalus
  • CSF fluid sampling for infection or diagnostic testing
  • Temporary drainage during certain neurosurgical procedures

In performing the above tasks, the EVD can “help prevent further brain injury caused by high [intracranial] pressure,” explained Poland.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC