Neurosurgery Coding Alert

Question: Our surgeon did a craniotomy for resection of skull base medial sphenoid wing meningioma. How do we report this? Do we report this with code 61519 (Craniectomy for excision of brain tumor, infratentorial or posterior fossa; meningioma) or 61521 (Craniectomy for excision of brain tumor, infratentorial or posterior fossa; midline tumor at base of skull)? Please advise.

New York Subscriber

Answer: You report code 61512 (Craniectomy, trephination, bone flap craniotomy; for excision of meningioma, supratentorial) for this situation. Sphenoid wing meningiomas are commonest skull base meningiomas and are located in the supratentorial compartment. Although the code 61521 also describes the excision of a midline skull base tumor, it is intended for excision of tumors other than a meningioma. Since your surgeon is excising a sphenoid wing meningioma, 61512 is the appropriate code.

Note: For excision of meningiomas or tumors in locations other than the skull base, you would typically use 61510 or 61512 for supratentorial tumors and either 61518 (Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor, or midline tumor at base of skull), 61518 or 61520 (Craniectomy for excision of brain tumor, infratentorial or posterior fossa; cerebellopontine angle tumor) for intratentorial tumors.

Tip:  Meningioma codes are applicable, regardless of whether the location is skull base or convexity.