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Multiple Cranioplasties

  1. #1
    Ft Myers, Florida
    Default Multiple Cranioplasties
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    My neurosurgeon repaired 3 separate cranial defects for a patient with multiple myeloma of the skull. I can not find any reference material to guide me as to how to best report this. The three areas together equal 5 cm (62140), or separately they are 1 cm, 1.5, and 3 cm, but I can't envision being paid 62141 x 3. However, they are 3 separate locations, requiring 3 separate repairs.
    Any ideas?

  2. #2
    Milwaukee WI
    Default Please post the operative report
    I think you will need to post the scrubbed operative report to get an accurate answer.

    You definitely will NOT be coding 62141 x 3 ... 62141 is for a defect measuring more than 5 cm and you reported in your question that the three defects are EACH smaller than that.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Ft Myers, Florida
    Hi Tessa,
    Thanks so much for answering. Here is the op note I am working on:

    Preoperative Diagnosis: Multiple myeloma with 3 cranial defects in the right hemicranium.

    Operative Procedure: Cranioplasty x 3 on the right, two 1-cm and one 3-cm defect.

    "Three cranial defects were easily identified. These were through and through. Sequentially, the soft tissue was removed using various curettes and kerrison rongeurs back to normal what appeared to be normal bleeding bone.

    The smallest defect was covered using a large bur hole plate and 6 screws. The moderate-sized defect, which was approximately 1.5 cm was covered using a kidney-bean shaped bur hole cover and approximately 8 screws. The large defect, which was over 3 cm was covered using titanium mesh and multiple screws."

    So, I am uncertain how to code this. In 6 years, I've never had a case like this and can not find any supporting documenation to guide me. The only thing that comes to mind is coding skin lesion removal when you add the total area to determine the code, but that really does not seem to equate.

    Any advice would be greatly appreciated!

  4. #4
    Milwaukee WI
    Default Wow ...
    This is NOT my area of expertise, ... but ... I'm stunned at how BRIEF this op report is ...

    Okay ... let's see what we have ...

    62140 has a work RVU of 14.550
    Here's the lay description: The physician corrects a defect in the cranium. In 62140, the defect is less than 5 cm. In 62141, the defect is greater than 5 cm. The physician incises and retracts the scalp. The bone flaps are lifted and remodeled. A prosthesis may be used to reapproximate the bony edges. The skull is stabilized and the scalp is reapproximated and sutured in layers.

    The problem I have with your op note is that I don't see any work to "lift and remodel" any "bone flaps." It seems that just one incision was made ... I'm assuming (perhaps incorrectly) that the scalp was then peeled back to reveal the defects.

    I'm leaning towards coding 62140 just one time. Although you usually code each lesion separately, there's no real guidance on this code. The total defects measured 5 cm (2 each at 1cm, plus another of 3 cm), and the brevity of the note doesn't make me think this required a significantly greater amount of work.

    Hope that's helpful to you. This is a real puzzle!

    F Tessa Bartels, CPC, CEMC

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