Neurosurgery Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: The neurosurgeon performed a craniotomy for aneurysm clipping. The patient developed a pneumo-cele postoperatively. To repair the pneumocele, the surgeon made a frontotemporal incision (from the previous surgery). He found a small hole in the left frontal sinus. He exenterated any mucosa and harvested an abdominal fat graft and placed it in the sinus. How should I code this? Is 31080-31081 correct?

Indiana Subscriber     Answer: Depending on the extent of the frontal exenteration, 31080 (sinusotomy, frontal; obliterative without osteoplastic flap, brow incision [includes ablation]), 31081 (... coronal incision), 31086 (... nonobliterative, with osteoplastic flap, brow incision) or 31087 (... coronal incision) will apply. Because you indicate that a fat graft is placed in the sinus (the sinus is obliterated), 31080-31081 is the correct choice. Report the fat graft separately using 20926 (tissue grafts, other [e.g., paratenon, fat, dermis]).
 
If a return to the operating room was necessary during the 90-day global period of the initial surgery (the craniotomy), apply modifier -78 (return to the operating room for a related procedure during the postoperative period) to the appropriate CPT codes.