Neurosurgery Coding Alert

Question: The physician determined that one of our patients had hydrocephalus and intraventricular hemorrhage. The patient underwent surgery in which the neurosurgeon made a small incision at the level of the coronal suture. The doctor removed a small portion of the right frontal bone, coagulated the dura and inserted a ventricular catheter for drainage. What code should I report?


Idaho Subscriber


Answer: If he used a twist drill to remove the frontal bone, you should report 61107 (Twist drill hole for subdural or ventricular puncture; for implanting ventricular catheter or pressure recording device). But if he made a burr hole, use code 61210 (Burr hole[s]; for implanting ventricular catheter, reservoir, EEG electrode[s] or pressure recording device [separate procedure]).

Typically, your physician will use the burr hole for more definitive procedures (such as ventriculoperitoneal shunts), and will use the (handheld) twist drill for quick catheterization of the ventricle, because it is packed with the catheter kit. Check the operative report (or consult with your doctor) to see which one applies in this case.