cerebrospinal fluid leak repair cpt code

#Cerebrospinal fluid leak repair cpt code code

The encephalocele was pulled through the bony defect. Using the microscope, the dura was separated from the middle cranial fossa until the dural defect and encephalocele were identified. A right temporal craniotomy was performed in a standard fashion. Keywords: Bone morphogenetic protein, cerebrospinal fluid leak, encephalocele, encephalocele repairĪ lumbar drain was inserted before surgery. It is our extrapolation that the pro-inflammatory properties of rhBMP-2 lead to the prevention of recurrent CSF leak.

On follow-up computed tomography imaging at 9 months’ postsurgery, there was no evidence of recurrent CSF leak or encephalocele, infection, ectopic bone formation, excessive inflammation, or neoplasm.Ĭonclusion:In this case, we demonstrate the successful use of BMP for the repair of CSF leak due to encephalocele. On postoperative clinic visits at 2 weeks and at 3 months, the patient demonstrated good recovery without evidence of recurrent CSF leak. Following, an absorbable sponge from the extra-small BMP kit was cut in half and soaked with recombinant human BMP-2 (rhBMP-2) before being laid over the bony defect. After resecting the encephalocele, cadaver crushed bone was used to fill the skull base defect. Herein, we demonstrate the safe and effective use of bone morphogenetic protein (BMP) in the repair of CSF leak caused by encephalocele.Ĭase Description:A retrospective chart review was conducted on a 50-year-old female who presented with sudden onset spontaneous right nostril CSF leak due to the right lateral sphenoid sinus recess encephalocele, for which she underwent surgical repair. Due to the rarity and variety in size and location of encephaloceles, no standard technique has been established for the resultant defect. They will appreciate it.Background:Encephaloceles are rare phenomena which occur when brain parenchyma herniates through a skull defect which, if left untreated, may lead to significant issues such as cerebrospinal fluid (CSF) fistulas, meningitis, and intractable seizures. Leave the neurosurgeons alone on this one. Resection of pituitary leaves an opening in the covering of the cerebrospinal fluid. If something out of the ordinary has to be done to fix an event that was NOT expected, that's a complication. Over the past ten years different substances have been tried and variations are common between neurosurgeons. It does NOT represent a complication of the surgery because, as you see, something is stuffed into the hole in all of these cases as part of the operation. Resection of pituitary tissue leaves a hole in the sella tursica and something has to be put into this hole to prevent brain tissue from oozing into it and to close the opening in the meninges that is part of the operation. Katy - these are NOT leaks - they are NOT complications of surgery. Is documentation clear enough to consider these complications? Do some/all require queries? Of course all say there were 'no complications' at the end of the OP note.Ĭlinical Documentation Program Coordinator

#Cerebrospinal fluid leak repair cpt code code

When I attempt to code a CSF leak I end up with G9782 and G960 but I am not sure. The dura defect and attachment of the tumor was removed completely with the tumor and was repaired utilizing SYNTHECEL, DuraGen and TISSEEL.' ('Repair of CSF leak with SYNTHECEL, DuraGen, TISSEEL.' Listed as a procedure) The sinus was repaired using TISSEEL, SYNTHECEL and 4-0 Nurolon sutures. Microsurgical resection of intratentorial meningioma:' The dura attachment of the tumor was meticulously bipolared with bipolar cautery. )' Repair of CSF leak with endonasal flap, Tisseel and abdominal fat graft.' Listed as a procedure)ģ. Repair of the dura was then finalized using Tisseel. Tritle and will be dictated separately, was then placed into the sphenoid sinus, and the sellar defect was then covered. The nasoseptal flap that was obtained by Dr. Endoscopic endonasal resection of pituitary tumor: Once it was felt that complete tumor resection had been achieved, an abdominal fat graft was obtained.

DuraSeal was then placed over the posterior wall and injected over the posterior wall, and there seemed to be good occlusion of the posterior wall with the DuraSeal with no evidence of egressive CSF.Ģ. Once tumor was resected, a piece of Gelfoam was placed into the top corner in the sella itself, and it seemed to abate the egressive CSF. Transsphenoidal endoscopic resection of pituitary adenoma: There was appearance of egressive CSF from the top corner. I am hoping someone with more neuro experience can help.ġ. But what is coming up frequently is when complications should be coded on these records. We are trying to review procedures more closely that we used to in I-9 to make sure PCS info is included.