Neurosurgery Coding Alert

Question: What CPT® code would be appropriate for frontal craniotomy for synangiosis when the diagnosis is moyamoya?

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Answer: There are two types of synangiosis performed for moyamoya disease. One can perform an encephaloduroateriorsynangiosis (EDAS) in which a superficial temporal artery is secured adjacent to the cortical surface or an encephalomyosynagnosis (EMS) in which temporalis muscle is secured to the cortical surface. Both procedures would be reported with the unlisted code 64999 (Unlisted procedure, nervous system). Another procedure performed for moyamoya disease, superficial temporal artery-middle cerebral artery (STA-MCA) bypass would be reported with 61711 (Anastomosis, arterial, extracranial-intracranial [eg, middle cerebral/cortical] arteries) for the bypass and 69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) for the utilization of an operating microscope.