Question Trephination

D.R.

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Would appreciate help on this. It seems to me the px was done to promote healing. I feel the trephination codes 611xx are for more extensive px(s). Would you use unlisted 21299 (craniofacial) ?? And if so what could be used as a comparison code? The physician suggested surgical prep & debridement codes which I don't agree with.

Procedure: Trephination of skull
The patient is status post a craniectomy for resection of the meningioma. She had multiple areas of nonhealing of her scalp after the radiation. She has been undergoing hyperbaric therapy but still has 1 open area of exposed calvarium with no periosteum. She presents today for an attempted trephination to get marrow to erupt by drilling holes in the outer calvarium. She was consented for this. We prepped her skull with Betadine paint allowing it to dry thoroughly. A Hall mini driver was obtained from the operating room. We used a 18-gauge wire and loaded it appropriately. Care was taken to choke up on the wire so that only a maximum of three quarters of a centimeter was showing. We use this to trephine 2 holes into the outer calvarium. From both holes a very small amount of bloody drainage was seen. This implied that we had entered the diploic space so we stopped. I applied bacitracin ointment to the areas. She will continue with her hyperbaric therapy and I will follow up with her at the wound center. She tolerated the procedure well and there were no complications.
Complications:
 
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