Neurosurgery Coding Alert

Question: The surgeon performed craniotomy and replaced the skull flap days later with titanium plates and screws. How should we report the skull flap replacement?

New Mexico Subscriber Answer: Report 62143 (Replacement of bone flap or prosthetic plate of skull). The surgeon likely planned the skull flap replacement prior to surgery. Therefore, this would qualify as a "staged procedure" and would require that you append modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) to 62143 if the surgeon replaces the skull flap within the 90-day global period of the primary procedure (in the case, the craniotomy). The operative reports for both surgeries should indicate clearly that the flap placement was preplanned.

If you fail to append modifier -58, and the surgery occurs within 90 days of the primary surgery, the carrier will likely reduce or even deny the procedure as included in the earlier craniotomy.

Likewise, if the replacement of the bone flap occurs at the same time as the initial craniotomy, the replacement is included in the charge for the craniotomy as part of the closure. - Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandham, CHC, CPC, compliance manager for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno.