Neurosurgery Coding Alert

Question: How does one report craniotomy for biopsy of brain lesion when the subsequent pathology report read, "Metastatic carcinoma, poorly differentiated adenocarcinoma, lung primary?" The surgeon did a right sided occipital stealth guided craniotomy and open biopsy.

Massachusetts Subscriber

Answer: When performing a biopsy for diagnosing a neoplasm, one must consider whether the biopsy was performed through a burr hole or craniotomy and whether image guidance or stereotactic guidance was required. Typical coding options include 61140 (Burr hole[s] or trephine; with biopsy of brain or intracranial lesion), 61750 (Stereotactic biopsy, aspiration, or excision, including burr hole[s], for intracranial lesion), 61751 (Stereotactic biopsy, aspiration, or excision, including burr hole[s], for intracranial lesion; with computed tomography and/ or magnetic resonance guidance). Since your example instead describes a craniotomy with neuronavigation assistance, the best option would be 61140-22 (Unusual procedural services:....) to describe the additional bony removal and 61781 (Stereotactic computer-assisted [navigational] procedure; cranial, intradural [List separately in addition to code for primary procedure]). An alternative option includes 61305 (Craniectomy or craniotomy, exploratory; infratentorial [posterior fossa]) and 61781. Unless the tumor itself was excised, 61518 (Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor, or midline tumor at base of skull) would not be as accurate.