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Fossa, dura, and approach are the keys for picking the right code. Getting into lesions in the intracranial area can be quite confusing and difficult, mostly in case your neurosurgeon uses a skull base approach -- which can include multiple skull base structures. Read this neurosurgery billing and coding expert three steps and you'll be able to code these procedures accurately. 1. Check the Fossa Site Firstly, while reporting skull base surgeries, check in the operative note the lesion location. A fossa is a hollow or depressed area. The skull is bifurcated into anterior, middle, and posterior fossae. Search for terms in the note like 'craniofacial' or 'orbitocranial' approach and terms talking about the bones of the face such as ethmoid, sphenoid, maxilla, and others to help confirm that the approach is through the anterior cranial fossa. Besides, keep in mind that the frontal lobe of the brain exists in the anterior cranial fossa, therefore the term 'frontal' is a clue for the anterior cranial fossa approach. On the contrary, the temporal lobe exists in the middle fossa, while the cerebellum and brainstem are found in the posterior fossa. 2. Study the Dura Access After you have confirmed the fossa where the pathology lies, study the operative note to ensure if the dura was opened up for excision of the intracranial lesion. The anterior approaches could either be intra- or extra-dural. Opposite to anterior fossa approaches, the surgical skull base approaches to the central and posterior fossa do not contain separate codes based on whether the dura is opened or not. For instance: You would report 61582 (Craniofacial approach to anterior cranial fossa; extradural, including unilateral or bifrontal craniotomy, elevation of frontal lobe(s), osteotomy of base of anterior cranial fossa) once the surgeon approaches through the anterior cranial fossa and carries out his job outside the dura. You would use 61583 (Craniofacial approach to anterior cranial fossa; intradural, including unilateral or bifrontal craniotomy, elevation or resection of frontal lobe, osteotomy ofbase of anterior cranial fossa) if the surgeon works through the dura to approach and lift the frontal lobe of the brain through a craniotomy in the covering frontal bones. 3. Decide the Approach Search for the details that identify whether the surgeon used a transfacial or transcranial approach. Your surgeon might use the facial approach to execute a graduated greater exposure that depends upon the extent of the disease. The simple approach might include a lateral rhinotomy along with a low craniotomy. Remember that there is a range of craniotomy codes that may be appropriate for the sort of lesion being treated. The skull base approach codes should only be used when substantial tissue dissection and bony removal are necessary to gain access to the skull base. Want to have more neurosurgery billing and coding expert tips and know everything about neurosurgery CPT codes? Click here to read the entire article and to get access to our monthly Neurosurgery Coding Alert: Your practical adviser for ethically optimizing coding, payment, and efficiency in neurosurgery practice Read more to perfect your neurosurgery billing and coding: http://www.supercoder.com/articles/articles-alerts/nec/coding-tips-use-3-tips-to-strengthen-your-skull-base-approach-coding-107423/
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