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Plastics and Neurosurgery for Extensive Craniectomy

  1. #1
    Default Plastics and Neurosurgery for Extensive Craniectomy
    Medical Coding Books
    We have a patient that we did extensive cranial vault reconstruction and the code for this is 61558. Both surgeons for Plastics and Neurosurgery acted as co-surgeons and the code does not allow for co-surgery.. Does anyone have suggestions how to handle this so both physicians get covered for their services? (was told there is a some kind of special way to bill this, but the person telling me this does not have an answer) Thanks for the help.

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    Ok...here's my take.

    Typically, Neurosurgeons provide the surgical access for 61558. 61558 does not require bone grafts, therefore, I could see why a co-surgeon isn't allowed. However, 61559 does require recontouring with bone grafts. 61159 does allow for assists/co-surgeons. In 61559, the neurosurgeon lifts off the cranium and the plastic surgeon performs the barrel-stave osteotomies and bone contouring. So...my question is...was 61559 the actual procedure performed?

  3. #3
    Default
    Yes, there was bone grafting involved... thanks for the help.

  4. Default
    Our plastic surgeon is providing exposure and the reconstruction (with grafts) for craniosynostosis (total calvarial vault remodeling). Our neurosurgeon is performing the craniotomies and barrel stave osteotomies (61559).

    Is the reconstruction by the plastic surgeon billed with 21172-21180 as suggested by the CPT note following 61559? We are confused by the CPT note following 21180 - for extensive craniectomy for multiple suture craniosynostosis, use ONLY 61558 or 61559.

  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default Co surgery not allowed
    When our plastic surgeons work with our neurosurgeons on these cases and the appropriate code for the craniectomy does not allow the co-surgeon modifier, the plastic surgeons use the applicable reconstruction code 21172-21180. We have not had major issues with payment.

    We get more issues with the co-surgeries - denials for duplicate claim (we're a large practice, same tax ID, though different specialties)

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 04-10-2009 at 12:17 PM.

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