Cranioplasty for skull defect

tboback

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I have a new Neurosurgeon starting soon. He asked me what code I would use for a cranioplasty for skull defect when he uses polymethyl methacrylate or PMMA instead of the patients own bone.

I think I would use 62146 Cranioplasty with autograft?

Can anyone confirm this for me?
 

penguins11

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I would look at 62140 and 62141. Codes 62146 and 62147 are if the physician harvests bone graft from the patient to repair the defect. However, also make sure he is not planning on billing for a cranioplasty with every cranial procedure. It is not routinely billed and I only bill it with a cranial procedure if the physician does a lot of extra work which does not include routinely mixing and placing the bone cement.
 
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Do we choose between 62146 and 62147 according on the size of the defect before the repair or after? I have a case where the cranial defect is less than five, but after the repair the size of the defect became more than 5. which code is more correct?
 
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