Neurosurgery Coding Alert

Question: My surgeon reported 61312 (Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural) as bilateral, which is being denied by Medicare. Is there a way to bill so this gets paid? I tried 61312-50 and 61312-59.

Answer: This is more complicated than it looks. If you have sent in corrected claims, then, yes, they will be denied. You must send an appeal along with whatever form your Medicare carrier requires and include a well marked operative report showing that there were two separate incisions. Underline each incision's documentation and put in the margin "Right side, First Incision" and "Second incision".) This procedure should be billable with the 59 modifier if it is truly two separate incisions/craniotomies. While the placement of burr holes for drainage of a subdural hematoma 61154 accepts the -50 bilateral modifier, the craniotomy code 61312 does not.