Neurosurgery Coding Alert

Question: One of our neurosurgeons performed a CT-guided stereotactic brain biopsy. A couple of hours after the surgery, the patient developed a hematoma, and the neurosurgeon had to perform a craniotomy for evacuation of the hematoma. The tumor was debulked. We are billing 61751 (stereotactic biopsy, aspiration, or excision, including burr hole[s], for intracranial lesion; with computerized axial tomography and/or magnetic resonance guidance) for the biopsy with CT guidance, and 61312 with modifier -78 (return to the operating room for a related procedure during the postoperative period) for the craniotomy to evacuate the hematoma. Is the debulking of the tumor included in the craniotomy code?

Betsy OConnor
Bryn Mawr, Pa.

Answer: If debulking is performed at the same time as drainage of the hematoma, the drainage is bundled into the debulking code. Use 61510 (craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma) with modifier -58 (staged or related procedure or service by the same physician during the postoperative period) to indicate that the procedure was performed for therapy following a diagnostic surgical procedure. If the hematoma drainage had been the only procedure performed after the biopsy, 61312 (craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural) with modifier -78 would have been appropriate. Do not use both modifiers on the claim. The -58 modifier indicates that the timing of code 61510 was made more immediate because of the intracranial bleed.