Skull Biopsy, No Burr Hole: 61500 or 61563?

September 30, 2009

Question: Our surgeon biopsied a lesion from the skull, but did not perform a craniectomy or create a burr hole for the procedure; he made an incision over the lesion and obtained the biopsy. How should I code this?

Answer: Your best option is 61500 (Craniectomy; with excision of tumor or other bone lesion of skull) though some coders might lean toward 61563 (Excision, intra and extracranial, benign tumor of cranial bone [e.g., fibrous dysplasia]; without optic nerve decompression). 61563 isn’t your best choice because there is no description of an intracranial component.

AUDIO: Neurosurgery Coding Boosters: Brain Tumor Excision vs. Hematoma Evacuation. With Dr. Greg Przybylski, Wednesday, October 7.

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