Neurosurgery Coding Alert

Question: The surgeon completed bifrontal craniotomy, periosteal sling with resection of mucocele, and closure of dural laceration. He diagnosed right frontal mucocele. Which procedures and diagnosis code do I report?

Nevada Subscriber

Answer: You have a couple of options to consider coding for this procedure, along with diagnosis 478.19 (Cyst or mucocele of nasal sinus) and any applicable fracture code:

• 62100 (Craniotomy for repair of dural/cerebrospinal fluid leak, including surgery for rhinorrhea/otorrhea) for the craniotomy if the surgeon did not perform a skull base approach with osteotomy. The mucocele treatment would be part of the dural/cerebrospinal fluid leak repair.

• 61582 (Craniofacial approach to anterior cranial fossa; extradural, including unilateral or bifrontal craniotomy, elevation of frontal lobe[s], osteotomy of base of anterior cranial fossa) for the skull base approach and 61600 (Resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; extradural) for the mucocele resection. You would not report 61618 (Secondary repair of dura for cerebrospinal fluid leak, anterior, middle or posterior cranial fossa following surgery of the skull base; by free tissue graft [e.g., pericranium, fascia, tensor fascia lata, adipose tissue, homologous or synthetic grafts]) because it is intended for subsequent surgery when prior skull base surgery resulted in a delayed CSF leak.