Burr Holes and Craniotomy

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Question:

We billed 61156 for the burr holes and 61312 for the craniotomy to removal a subdural hematoma. The insurance company denied 61556 but paid 61312. I’ve appealed the denial twice but they are adamant about not paying. I’m thinking about balance billing the patient for this charge. What do you think I should do?

Answer:

We think you should just write off your charge for 61156. This code should not have been billed in the first place because making the burr holes is included in all craniotomy codes. It is not appropriate to balance bill the patient for a charge that should not have been billed. The only time separate burr holes are billable are when they are performed as a completely separate procedure and not a part of the craniotomy exposure.