Chiari decompression (61343)

cmorosky

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Our surgeon performed a Chiari Decompression (61343) with a pericranial autograft patch from a seperate scalp incision. Based on the coding description for 61343 the graft is included. The physician states since the graft was from a separate incision we should add code 20926 and use modifier 59. Would appreciate additional feedback, do you agree we should code 20926 with a 59 modifier since the graft is from a seperate scalp incision. He only feels code 20926 bundles when the graft is taken from the same incision.
 

penguins11

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I dont know, his logic seems a little sketchy too me. In the description of the code in the Ingenix Neurosurgery guide, it states, "If a dural graft is needed to cover the resulting defect, fascia is harvested from the thigh or a cadaveric dural grafit is used..." Both of those certainly would be from a separate incision and/or source. It also states under coding tips that "Any tissue harvested for dural graft is included in the procedure and should not be reported separately." I would not code 20926. I would be happy to fax you the page that I am looking at if your dr requires more proof.
 
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