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Cerebrospinal fluid leak repair cpt code12/10/2023 We have found that many payers fail to recognize, and appropriately reimburse, claims where both surgeons report the same unlisted code with modifier 62 (e.g., 64999-62). Many otolaryngology and neurosurgery practices have implemented a successful coding and reimbursement strategy for performing endoscopic skull base surgery procedures together. Both the AAO-HNS and the American Association of Neurological Surgeons agree it is not accurate to use the existing skull base surgery CPT codes for endonasal/endoscopic procedures because the existing codes describe an open procedure involving skin incision(s). Therefore, endonasal/endoscopic skull base procedures, except the endoscopic resection of a pituitary tumor (62165), do not have a CPT code. Endonasal/endoscopic skull base surgery is relatively new and performed in a limited number of organizations. The existing open (involving a skin incision) skull base surgery CPT codes were introduced to the CPT code system in 1994. Modifier 62 (two surgeons) is appended to 62165 when performed as co-surgery involving the otolaryngologist (ORL) and neurosurgeon (NS) to show that neither surgeon performed the entire procedure code. Only one CPT code exists for an endoscopic skull base procedure-62165, Neuroendoscopy, intracranial with excision of a pituitary tumor, transnasal, or trans-sphenoidal approach. Unlike the skull base surgery codes that include separate codes for the approach and definitive procedure, CPT 62165 includes the approach, tumor resection, and closure. The contemporary practice of medicine is occasionally ahead of the CPT code system and an accurate code may not always exist for the procedure performed this is true for reporting most endoscopic/endonasal skull base surgery procedures.Coding Issues The American Medical Association’s Current Procedural Terminology® (CPT) codes for reporting medical services and procedures performed by physicians must be used to bill services to third party payers. ![]() They will appreciate it.Coding and Reimbursement Strategies: Using an Unlisted Code for Endoscopic Skull Base Surgery Leave the neurosurgeons alone on this one. Resection of pituitary leaves an opening in the covering of the cerebrospinal fluid. If something out of the ordinary has to be done to fix an event that was NOT expected, that's a complication. Over the past ten years different substances have been tried and variations are common between neurosurgeons. It does NOT represent a complication of the surgery because, as you see, something is stuffed into the hole in all of these cases as part of the operation. Resection of pituitary tissue leaves a hole in the sella tursica and something has to be put into this hole to prevent brain tissue from oozing into it and to close the opening in the meninges that is part of the operation. Katy - these are NOT leaks - they are NOT complications of surgery. Is documentation clear enough to consider these complications? Do some/all require queries? Of course all say there were 'no complications' at the end of the OP note.Ĭlinical Documentation Program Coordinator When I attempt to code a CSF leak I end up with G9782 and G960 but I am not sure. The dura defect and attachment of the tumor was removed completely with the tumor and was repaired utilizing SYNTHECEL, DuraGen and TISSEEL." ("Repair of CSF leak with SYNTHECEL, DuraGen, TISSEEL." Listed as a procedure) The sinus was repaired using TISSEEL, SYNTHECEL and 4-0 Nurolon sutures. Microsurgical resection of intratentorial meningioma:" The dura attachment of the tumor was meticulously bipolared with bipolar cautery. )" Repair of CSF leak with endonasal flap, Tisseel and abdominal fat graft." Listed as a procedure)ģ. Repair of the dura was then finalized using Tisseel. Tritle and will be dictated separately, was then placed into the sphenoid sinus, and the sellar defect was then covered. ![]() The nasoseptal flap that was obtained by Dr. Endoscopic endonasal resection of pituitary tumor: Once it was felt that complete tumor resection had been achieved, an abdominal fat graft was obtained. DuraSeal was then placed over the posterior wall and injected over the posterior wall, and there seemed to be good occlusion of the posterior wall with the DuraSeal with no evidence of egressive CSF.Ģ. Once tumor was resected, a piece of Gelfoam was placed into the top corner in the sella itself, and it seemed to abate the egressive CSF. Transsphenoidal endoscopic resection of pituitary adenoma: There was appearance of egressive CSF from the top corner. I am hoping someone with more neuro experience can help.ġ. ![]() But what is coming up frequently is when complications should be coded on these records. We are trying to review procedures more closely that we used to in I-9 to make sure PCS info is included.
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