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Thread: Craniotomy coding question

  1. #1
    Join Date
    Apr 2007

    Default Craniotomy coding question

    AAPC: Back to School
    Good Afternoon!

    I have a case that is stumping me. I could not find a crani code that was specific for this malformation. Could you please review and see if you can assist me with the crani code you would use?

    The dx is: Right frontal cavernous malformation 4x3x3 cm

    The procedure performed is: Right bicoronal/frontal craniotomy for cavernoma resection.

    The operative report reads: ....The temporalis fascia was then incised circumferentially and the temporalis was mobilized inferiorly with a periosteal and held into place with two interrupted 2-0 Vicryl sutures. Burr holes were then performed anteriorly and posteriorly in the frontal region as well as in the middle of the superficial protion of the awuamous temporal bone. The dura was then dissected from the overlying skull with a #3 Penfield. The craniotome was then used to connect the burr holes and a right frontal craniotomy bone flap was removed fro mthe field. Hemostasis was then obtained with the bipolar and dura was opened in a cruciate fashion with a #15 blalde. The four dural leafs were then tacked back with interrupted 4-0 Nurolon sutures. At the point in time, the BrainLab neuronavigation was utilized to identify the most cortical representation of the cavernous malformation. This was adjacent to a large vein and at this point in time the microscope was brought into the field. Under direct microscopic vision, significant microdissection was performed. An arachnoid knife was used to make a small incision in the arachnoid just posterior to this large temporal draining vein. The microscissors and gentle suction were then used to carefully dissect in the arachnoid plane. At this point in time, a large amount of hemosiderin was identified which was felt ot represent the cavernous malformation. The plane between the cavernous malfomation and the brain was then gently established posteriorly with the bipolar, a Rhoton #6 dissector, and controlled suction. This plane was then marked with a quarter-inch cotton patty and then dissection was carried medial. The posterior medial plane was then identified with controlled suction and the bipolar and the cavernoma was continuously shrunk with the bipolar until it was smaller dimensions. After these planes were established and marked with the quarter-inch cotton patties, attention was then addressed anteriorly and laterally. The anterior plane between the cavernous malformation of the brain was then established with the bipolar and then a large portion of the cavernoma was debulked with tumor scissors. This was sent to pathology for frozen analysis. After debulking of a large central portion of the cavernous malformation, dissection was then carried deep anteriorly untl the deep margins of cavernous malformation were identified. this was once again marked with quarter-inch patties. the last plane laterally was then established and dissection was carried deep and once again this plane was marked with quarter-inch cotton patties. At the completion of this, a large central portion of the cavernous malformation was debulked with tumor scissors and then the cavenoma was removed en bloc with the tumor forceps. This was then sent to pathology for permanent analysis. The surrounding edematous white matter wan then carefully inspected with the bipolar and there was thought to be no residual cavernoma. Hemostasis was then obtained with Surgicel which was used to line the resection cavity. The wound was the copiously irrigated with saline and there was no evidence of further hemorrhage. The microscope was then removed from the field. The dura was then reapproximated with running 4-0 Nurolon sutures. Hemostasis in the epidural space was obtained with the bipolar and powdered Gelfoam. The bone flap was then secured to the skull with 3 plates and 6 screws. The temporalis fascia was then reapproximated with interrupted 2-0 Vicryl sutures. A methyl methacrylate cranioplasty was performed to fill the 2 burr holes anteriorly and posteriorly as well as to line the margins of the craniotomy flap. At the completion of this, the wound was copiously irrigated with antibiotic solution. the galea was then reapproximated with interrupted 2-0 Vicryl sutures. The skin was then closed with staples.....

    Thanks for your help!

  2. #2


    It has been a while since I coded Neurosurgery, but I would look at 61680-61684, plus 69990 for the microscope. Good luck!

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