Neurosurgery Coding Alert

Question: What differentiates a "simple" from a "complex" intracranial aneurysm? Mississippi Subscriber Answer: Codes 61697 (Surgery of complex intracranial aneurysm, intracranial approach; carotid circulation) and 61698 (... vertebrobasilar circulation) describe surgery of complex intracranial aneurysm, while 61700 (Surgery of simple intracranial aneurysm, intracranial approach; carotid circulation) and 61702 (... vertebrobasilar circulation) describe "simple" intracranial aneurysm procedures. CPT includes a parenthetical explanation stating, "61697, 61698 involve aneurysms that are larger than 15 mm or with calcification of the aneurysm neck, or with incorporation of normal vessels into the aneurysm neck, or a procedure requiring temporary vessel occlusion, trapping or cardiopulmonary bypass to successfully treat the aneurysm." In other words: The aneurysm qualifies as complex either because of its large size or because of the need for extra effort to clip it or prevent further damage to the blood vessels. Despite the name, an aneurysm that CPT guidelines define as "simple" may still require a complicated or difficult treatment. -- Technical and coding guidance for You Be the Coder and Reader Questions provided by Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.