How To Use CPT Code 61322

CPT 61322 describes a surgical procedure used to treat intracranial hypertension by removing a part of the skull to allow the swelling brain room to expand. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 61322?

CPT 61322 can be used to describe a surgical procedure in which a part of the skull is removed to treat intracranial hypertension. This procedure allows the swelling brain to have more space to expand and relieve pressure. It may also involve duraplasty, which is the reconstruction or expansion of the dura, the outermost membrane that covers the brain. This code specifically excludes the removal of a related hematoma and does not involve dissection of the lobes of the brain.

2. Official Description

The official description of CPT code 61322 is: ‘Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; without lobectomy.’

3. Procedure

1. The provider begins by making an incision in the skull and creating a large U-shaped opening.
2. Next, the provider folds back the tissue to expose the bone and drills burr holes in the skull.
3. Using a surgical saw called a craniotome, the provider cuts between the burr holes to create a bone flap, which is then removed to expose the dura.
4. If necessary, the provider may open the dura and reduce the intracranial pressure by exposing the swollen brain.
5. After controlling bleeding and reducing pressure, the provider closes the dura with sutures or a graft to allow for expansion.
6. If possible, the provider replaces the bone flap; otherwise, it may be preserved or placed in a subcutaneous pocket in the abdominal area.
7. The provider then closes the wound in layers.

4. Qualifying circumstances

CPT 61322 is used for patients with intracranial hypertension, which is elevated pressure inside the skull. The procedure is performed to relieve this pressure and allow the brain to expand. It does not involve the removal of a related hematoma or dissection of the lobes of the brain. The code may also include duraplasty, which is the reconstruction or expansion of the dura, the outermost membrane that covers the brain.

5. When to use CPT code 61322

CPT code 61322 should be used when a craniectomy or craniotomy is performed to treat intracranial hypertension without the evacuation of an associated intraparenchymal hematoma. It is important to note that this code specifically excludes the removal of a hematoma and does not involve dissection of the lobes of the brain.

6. Documentation requirements

To support a claim for CPT 61322, the provider must document the following information:

• Diagnosis of intracranial hypertension
• Description of the procedure performed, including whether duraplasty was included
• Date of the procedure
• Details of the surgical approach, including the incision and bone flap creation
• Any complications or unexpected findings
• Closure of the dura and replacement or preservation of the bone flap
• Signature of the provider

7. Billing guidelines

When billing for CPT 61322, ensure that the procedure meets the criteria outlined in the official description. It is important to note that this code should not be reported if CPT code 61313 has already been performed. Additionally, consider the location of the procedure and any modifiers that may be necessary to accurately report the service.

8. Historical information

CPT 61322 was added to the Current Procedural Terminology system on January 1, 2003. It was later added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A patient undergoes a craniectomy to relieve intracranial hypertension caused by swelling of the brain.
2. A provider performs a craniotomy with duraplasty to treat elevated pressure inside the skull without the evacuation of an associated hematoma.
3. A surgical team performs a decompressive craniectomy to allow the brain to expand and relieve pressure in a patient with intracranial hypertension.
4. A provider performs a craniotomy with duraplasty to reconstruct the dura and treat elevated pressure inside the skull.
5. A patient undergoes a craniectomy without the removal of a hematoma to relieve intracranial hypertension caused by swelling of the brain.
6. A provider performs a craniotomy with duraplasty to expand the dura and treat elevated pressure inside the skull.
7. A surgical team performs a decompressive craniectomy to relieve pressure on the brain in a patient with intracranial hypertension.
8. A provider performs a craniotomy with duraplasty to reconstruct the dura and treat elevated pressure inside the skull without the removal of a hematoma.