Neurosurgery Coding Alert

Question: My physician coded 61510 x 3 because the tumor overlapped several areas. His documentation states, "left frontotemporal craniotomy with stealth neuronavigation system. Frameless stereotactic volumetric resection of invasive metastatic carcinoma." A small piece of soft tissue adherent to the bone flap confirmed adenocarcinoma, so he placed a titanium mesh plate and screws instead of replacing the bone flap. Should I follow my physician's coding advice? Connecticut Subscriber Answer: Your physician is thinking of the correct code, but he wants to report it too many times. Code 61510 (Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma) represents everything supratentorial. It appears that your surgeon performed one craniotomy and made a single incision, so you report 61510 only once. Then add +61795 (Stereotactic computer-assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal [List separately in addition to code for primary procedure]) for the stealth navigation. Modifier note: If [...]