Neurosurgery Coding Alert

Question: The surgeon performed a right parietal craniotomy with gross total resection of a meningioma. He also performed duraplasty with a dural graft. How should this be reported?

Rhode Island Subscriber
Answer: Report 61512 (Craniectomy, trephination, bone flap craniotomy; for excision of meningioma, supratentorial) for the craniectomy and meningioma excision. If an autograft is harvested, report 20926 (Tissue grafts, other [e.g., paratenon, fat, dermis]). This procedure is modifier -51 (Multiple procedures) exempt. If any other type of graft is used, the surgeon does not bill separately.
 
Closure (including water-tight repair of the dura) is included in 61512, whether the original dura or a replacement (graft) is used. If the duraplasty is performed at a different session to repair a leak subsequent to surgery, however, the procedure is separately billable using 62100 (Craniotomy for repair of dural/cerebrospinal fluid leak, including surgery for rhinorrhea/otorrhea) or 64999 (Unlisted procedure, nervous system), as required per payer guidelines, with modifier -78 (Return to the operating room for a related procedure during the postoperative period) appended. Also, use of an operating microscope (69990) is separately billable with 62100, per CMS guidelines.