Neurosurgery Coding Alert

Question: Would the appropriate code for a retrosigmoid suboccipital craniectomy for mass resection (malignant lymphoma) be 61458 (Craniectomy, suboccipital; for exploration or decompression of cranial nerves)? This was not done for trigeminal neuralgia however our surgeon dissected out a number of cranial nerves as the mass was encircling the lower cranial nerves and brain stem.New Hampshire SubscriberAnswer: The code 61458 code is specifically for decompression of cranial nerves and does not include the work for the tumor removal. In your case, since the pathology was lymphoma in the posterior fossa, you should look at 61518 (Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor, or midline tumor at base of skull).