Question: For the patient with a diagnosis of a clinoidal meningioma, your surgeon carried out a stereotactic pterional osteoplastic craniotomy along with resection of clinoidal/sphenoid wing mass. For the microdissection in surgery, he used an intraoperative microscope. Prior to decompressing the superior orbital fissure, the tumor was extirpated through the opticocarotid, carotid "oculomotor, as well asprechiasmatic spaces. Furthermore, your surgeon carried out an intraoperative electrophysiological monitoring by means of SSEPs and motor evoked potentials. How do you report this procedure?
Answer: You report CPT code 61512 (Craniectomy, trephination, bone flap craniotomy for excision of meningioma, supratentorial). Generally, skull base codes are not reported if a craniotomy code specific to the procedure takes place.
In case there is documentation for a skull base approach, after that you would pair the suitable approach code for the location of the neoplasm (anterior v. middle fossa, intradural v. extradural) with the definitive resection code of the similar anatomical site.
As both microdissection and stereotactic navigation are defined, you may also go ahead and report the add-on CPT codes +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) for the microsurgical dissection and +61781 (Stereotactic computer-assisted [navigational] procedure; cranial, intradural [List separately in addition to code for primary procedure]) for the navigational procedure. Remember that the neurophysiological monitoring can never be reported by a member of the operating team.
You Must Now Report Laminectomy Code With 63655
Question: Can you bill together for a laminectomy meant for decompression of nerve roots carried out at the same side of spinal cord stimulation (SCS) implant? The patient had a spinal stenosis in the thoracic region and the SCS was placed at the similar level.
The patient’s OP report mentions "laminectomy from T9-T10, AMA drill was brought in use to further expand the laminectomy for decompression. A set of instruments was used to accomplish neurolysis at this level……"
Answer: The CPT code 63655 (Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural) contains the laminectomy done to implant the electrodes. You cannot report the laminectomy CPT codes like 63003 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy [eg, spinal stenosis], 1 or 2 vertebral segments; thoracic) with 63655 at the similar level.