Summary & Overview
CPT 61345: Posterior Fossa Decompression (Suboccipital Craniectomy)
CPT code 61345 represents posterior fossa decompression — a neurosurgical procedure removing part of the occipital bone and upper cervical bone to relieve pressure at the base of the brain. This procedure is used to treat acute cerebellar strokes, intracranial hemorrhages, posterior fossa tumors, tonsillar herniation, and Chiari malformation, conditions that can cause life‑threatening brainstem compression or obstructive hydrocephalus. Nationally, accurate coding for this complex inpatient procedure matters for clinical tracking, surgical quality measurement, and appropriate payment for high‑acuity neurosurgical care.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a compact overview of the clinical context, typical sites of service, and the kinds of benchmarks and policy issues relevant to 61345 billing, including utilization patterns, inpatient surgical reimbursement considerations, and coding nuances that affect claim acceptance. The publication also outlines where to look for related documentation and clinical indicators that commonly accompany this procedure. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 61345 describes a neurosurgical procedure in which a portion of the occipital bone and the upper cervical vertebrae are removed to decompress the posterior fossa at the base of the brain. The procedure is performed to relieve pressure caused by cerebellar strokes, hemorrhages, tumors, as well as to address tonsillar herniation and Chiari malformation, where brain tissue extends into the spinal canal due to an abnormally small or misshapen skull.
-
Service type: Surgical decompression of the posterior fossa / suboccipital craniectomy with or without upper cervical laminectomy
-
Typical site of service: Inpatient operating room, often followed by intensive care unit or acute inpatient post‑operative care
Clinical & Coding Specifications
Clinical Context
A 38-year-old patient presents to the emergency department with acute severe occipital headache, progressive nausea, vomiting, and declining level of consciousness after a posterior fossa hemorrhagic stroke. Neuroimaging (CT and MRI) demonstrates mass effect at the foramen magnum with cerebellar tonsillar descent and obstructive hydrocephalus. Neurosurgery evaluates the patient and determines that suboccipital craniectomy with removal of a small segment of the occipital bone and upper cervical lamina (posterior fossa decompression) is required to relieve brainstem compression and restore cerebrospinal fluid flow. The clinical workflow includes urgent preoperative consent, anesthesia evaluation, placement in prone position, suboccipital bone removal with possible dural opening and duraplasty, intraoperative neuromonitoring, postoperative ICU monitoring for neurologic status and intracranial pressure, follow-up imaging, and rehabilitation planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when intraoperative complexity or extra work (extensive dissection, significant blood loss, prolonged operative time) substantially exceeds typical for this procedure. |
23 |