Neurosurgery Coding Alert

Question: For the patient who was diagnosed a clinoidal meningioma, our surgeon did a stereotactic pterional osteoplastic craniotomy with resection of clinoidal/sphenoid wing mass. For the microdissection during surgery, he used an intraoperative microscope. After decompressing the superior orbital fissure, the tumor was extirpated through the opticocarotid, carotid"oculomotor, and prechiasmatic spaces. In addition, our surgeon did an intraoperative electrophysiological monitoring with SSEPs and motor evoked potentials. How do we report this procedure?

Alaska Subscriber

Answer: You report code 61512 (Craniectomy, trephination, bone flap craniotomy for excision of meningioma, supratentorial). In general, skull base codes are not reported if a craniotomy code specific to the procedure exists.

If there is documentation for a skull base approach, then you would pair the appropriate approach code for the location of the neoplasm (anterior v. middle fossa, intradural v. extradural) with the definitive resection code of the same anatomical site.

Since both microdissection and stereotactic navigation are described, you may also report the add-on codes +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) for the microsurgical dissection and +61781 (Stereotactic computer-assisted [navigational] procedure; cranial, intradural [List separately in addition to code for primary procedure]) for the navigational procedure. The neurophysiological monitoring cannot be reported by a member of the operating team.