Skull Base Surgery

Skull Base Surgery

March 28, 2019

Question:
My neurosurgeon did a craniotomy with removal of a frontotemporal meningioma with stereotactic navigation and the microscope.  I coded as 61512, 61781, and 69990-59. However, my doctor disagrees and wants to code as 61583, 61512-51.  What do you think?

Answer:
First, 61583 – a skull base surgery approach code that requires an osteotomy at the base of the anterior cranial fossa – cannot be reported with 61512 (craniotomy for supratentorial meningioma) because 61512 includes the approach.  Using both codes – 61583 and 1512 – is “double-dipping” on the approach.  We would need to see the operative note to recommend definitive CPT codes but it sounds, from your description, that 61512, 61781 and 69990-59 fit the procedure.

For more information on skull base surgery coding, please refer to Kim’s white paper, “Coding and Reimbursement for Endoscopic Endonasal Surgery of the Skull Base,” in the February 2019 issue of the Journal of Neurological Surgery. Here is the link: https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0039-1677682  (member login required to read the full text).

*This response is based on the best information available as of 3/28/19.

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