Pre-op Dx: bilateral acute subdural hematoma with brain compression, left parietotemporal skull base fractures with displacement.

Procedure: Craniectomy and ventriculostomy placement.

Op notes: Two burr holes were placed, due to significant comminuted fractures in the parietal region, no further burr holes were placed. Bone flap lifted without difficulty. There were free fragments identified posteriorly, which were removed. Dura was found to be disrupted with brain herniating through the defect as well as has been noted through the calvarial defect, area irrigated copiously. Dura was further opened and craniectomy carried down to the temporal region. Epidural and subdural hemotoma noted, which was evacuated. Area was copiously irrigated and all free fragments and hematoma evacuated. Brain pulsation was noted and found to be slightly sunken, however, posterior aspect was significantly swollen. Hence, decision was made to keep the bone flap off using placement of a ventricular catheter. A small 15 blade was used to incise the brain parenchyma superficially and an EVD ventriculostomy catheter was placed.

The catheter was not removed at completion of surgery.

There are 3 arguments as to how this should be billed:

1. 61322, 62005-51, 61154-51
2. 61322, 61312-59, 62005-51
3. 61312, 62005-51

The burr holes were drilled for the purpose of the craniectomy, not the drainage of the hematoma, so I don’t feel 61154 is accurate. I feel that the 61322 is more precise, but would I bill this WITH the 61312-59?

Also, the doctor placed the ventriculostomy catheter and it seems like there should be a code for this, but I cannot find one. He did not perform a neuroendoscopy and he used the existing burr holes. Can anyone offer guidance on this as well?