Summary & Overview
CPT 61323: Decompressive Craniectomy with Partial Brain Resection and Duraplasty
CPT code 61323 covers a neurosurgical decompressive craniectomy with removal of a portion of damaged brain tissue to reduce elevated intracranial pressure, and may include duraplasty to reconstruct or expand the dura. Nationally, this code represents a high-acuity, inpatient neurosurgical intervention performed in settings that manage traumatic brain injury, malignant cerebral edema, or other causes of life‑threatening intracranial hypertension. It matters because it defines a complex operative service with implications for hospital resource use, clinical outcomes, and insurer coverage determinations.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical context of the procedure, typical site-of-service expectations, common billing modifiers associated with complex operative care, and where to find guidance when linking this code to diagnoses and inpatient claims. The publication also outlines benchmarks for utilization and policy considerations relevant to hospital and payer coding reviews.
This summary is intended for a national audience of clinicians, coding professionals, and policy analysts seeking a concise reference on the clinical definition and billing context for CPT code 61323.
Billing Code Overview
CPT code 61323 describes a surgical procedure in which the provider removes a portion of the skull (craniectomy) and resects a portion of damaged brain tissue to relieve elevated intracranial pressure (ICP) by allowing the swollen brain room to expand. The procedure may include duraplasty, the reconstruction or expansion of the dura mater using a synthetic graft or the patient’s pericranium. The description explicitly excludes removal of the related hematoma.
Service type: Neurosurgical decompressive craniectomy with partial brain resection and possible duraplasty
Typical site of service: Inpatient operating room or inpatient neurosurgical unit
Clinical & Coding Specifications
Clinical Context
A 46-year-old male is brought to the emergency department after a high-speed motor vehicle collision with decreased level of consciousness and clinical signs of elevated intracranial pressure (ICP). Noncontrast head CT shows cerebral edema with midline shift without a surgically evacuable hematoma. Neurosurgery evaluates the patient and determines an urgent decompressive craniectomy with possible duraplasty is indicated to allow the swollen brain to expand and to reduce ICP. The operating room team performs general endotracheal anesthesia, positions the patient, and completes a large frontotemporoparietal hemicraniectomy. The dura is opened, nonviable brain tissue is debrided as indicated, and a duraplasty is performed using a synthetic graft to expand the dural envelope. The bone flap is typically stored for potential future cranioplasty. Postoperatively, the patient is transferred to the neurocritical care unit for intracranial pressure monitoring, ventilatory support, hemodynamic management, and serial neurologic exams. Imaging and neurological assessments guide timing of delayed cranioplasty. Documentation includes indication, preoperative neurologic status, imaging findings, specific anatomic extent of bone removal, whether duraplasty or graft was performed, whether hematoma evacuation was performed (excluded from this code), anesthesia type, complications, and disposition.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Office or other outpatient visit | Not typically used with operative CPT; included for completeness when reporting an unrelated visit on the same day by same provider |