Bone Flap

Scenario: "The previous bifrontal craniotomy incision was reincised and the bone flap carefully removed for later reimplantation." This was done by another surgeon.

"...and then Dr. Marshall (our surgeon) of the general surgery team implanted the bone flap in the subcutaneous tissue of the abdominal wall."

The only code I can find is the +61316 for Dr. Marshall but it is an add on code. Does any one have any clue as to what code I'd use as prime as he had nothing to do w/ the craniotomy part of the surgery. I'm thinking something w/ the abdominal wall (incision) but not sure.

Any ideas? :)

Bone flap reply

You are correct - +61316 is the correct code but your doctor did not do the primary surgery for which this code would be "added on". I recommend you use an intermediate (1203x) or complex (1310x) code instead.

Kim Pollock, RN, MBA, CPC
KarenZupko & Associates, Inc.
www.karenzupko.com