Neurosurgery Coding Alert
I.D. Craniosynostosis Type for Optimal Coding
Surgery type depends on specifics of condition. When a patient is suffering from craniosynostosis, surgery may be necessary as soon as possible — as this is a condition that affects newborns and infants and treatment windows can be narrow. Just as the surgeon will have to act decisively, the coder will need to line up the surgery code for the fix with the correct ICD-10 code before submitting the claim. Get the basics on coding for craniosynostosis with this primer. Know Craniosynostosis Definition Before coding for craniosynostosis, a definition should make things clearer. Craniosynostosis is a birth (congenital) defect where one or more sutures in a baby’s skull close too early, causing problems with skull growth, shape, and symmetry. Normally, the sutures in a baby’s skull allow for growth and expansion of the skull as the brain grows during the first few years of life. However, in craniosynostosis, one or more of these sutures close too early, before the brain has fully developed. This premature closure of sutures can lead to abnormal skull shape, skull and facial asymmetries, and restricted brain growth. The diagnosis of craniosynostosis is usually made based on physical examination and imaging tests, such as X-rays or computed tomography (CT) scans. You’ll code any physical exam services your surgeon provides in search of craniosynostosis with an evaluation and management (E/M) code, likely 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.). Be on the lookout for other types of E/Ms as well, though; the E/M could also be an inpatient code. When the surgeon opts for X-rays or CT scans, here are the most likely codes you’ll report for the service (although contrast CT would not typically be needed): Example: Encounter notes indicate that the surgeon performed a level-five office/ outpatient E/M for a new patient. After the physical exam, the surgeon orders a head CT without contrast material, which confirms sagittal craniosynostosis. The surgeon did not own the CT scan equipment. For this encounter, you’d report: Craniosynostosis Tx Involves These Surgeries, Dx Codes Treatment for craniosynostosis often involves surgery to release the fused sutures and reshape the skull. The goal of surgery is to allow for normal brain growth and improve the appearance of the head. Early intervention is important in craniosynostosis to prevent potential complications and ensure optimal brain development. Check out this list of surgeries for craniosynostosis, along with the ICD-10 codes you’re likely to see paired with them: CPT® Codes The basics: In this procedure, the provider makes an incision to access the affected cranial suture, excises the prematurely fused suture, and reshapes the skull bone to an anatomically appropriate position. ICD-10 Codes The following codes are often associated with claims for 61550 or 61552: CPT® Codes The basics: For 61556 claims, the provider makes an incision in the skull to remove a frontal or parietal bone flap to treat prematurely fused cranial sutures and remodels the skull to its anatomically appropriate shape. For 61557 claims, the provider makes an ear-to-ear incision in the skull to create a bilateral frontal bone flap to remodel the skull to its anatomically appropriate shape. ICD-10 Codes The majority of the codes listed for 61550 and 61552 are also accepted for 61556 and 61557, but check your payer contracts to be sure. Also, the following diagnosis codes may accompany claims for 61556 and 61557: CPT® Codes The basics: For 61558 and 61559 claims, the provider makes incises the skull to remove the cranium and remodel the skull to its anatomically appropriate shape. ICD-10 codes: The majority of the codes listed for 61550 and 61552 are also accepted for 61558 and 61559, but check your payer contracts to be sure. Also, the following diagnosis codes may accompany claims for 61558 and 61559:
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