In A Long-standing Hydrocephalus Code For Cranial Expansion

By Author: erinarticle
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In a particular situation, the neurosurgeon carried out a cranial expansion in a longstanding hydrocephalus that was not controlled by shunts. After removing the sagittal bone over the sagittal sinus, he circumferentially thinned the inner table underneath the frontal and parietal regions. A decompressive subtemporal craniectomy was carried out and the cranial bones were returned in hinge fashion with resorbable plating system. The pre-op and post-op diagnosis reads ‘headaches, likely raised intracranial pressure.' Is ICD code 784 proper for this situation? Can 61322 (Craniectomy or craniotomy, decompressive with or minus duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; without lobectomy), 61340 (Subtemporal cranial decompression (pseudotumor cerebri, slit ventricle syndrome)) and 61559 (Extensive craniectomy for multiple cranial suture craniosynostosis (example, cloverleaf skull); recontouring with multiple osteotomies and bone autografts (example, barrel-stave procedure) (includes obtaining grafts) be billed together for this procedure?
The code 61322 ...
... is meant for use in acute increased intracranial pressure such as after large stroke or traumatic brain injury, or traumatic brain injury, and as such does not apply in this clinical situation. 61340 (Subtemporal cranial decompression (pseudotumor cerebri, slit ventricle syndrome) aptly reflects the subtemporal decompression performed for longstanding hydrocephalus. While resection of the sagittal suture indicates consideration of one of the craniectomy codes for craniosynostosis, the patient's condition as described is not connected to premature suture fusion. As a result, one should use the unlisted code 64999 to mirror the excision of the sagittal suture and the thinning of the bony frontal and parietal inner tables. Here the ICD-9 code would be one for hydrocephalus (331.3 to 331.9), depending on the type and cause for hydrocephalus. The symptom of headaches in this case wouldn't be coded separately.
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