Summary & Overview

CPT 61619: Dural CSF Leak Repair with Pedicle Flap After Craniotomy

CPT code 61619 represents a neurosurgical procedure to repair a cerebrospinal fluid (CSF) leak of the dura mater using a pedicle flap following a craniotomy. This code is used to report definitive operative management of postoperative or iatrogenic dural defects where a vascularized flap is employed to restore dural integrity and prevent ongoing CSF leakage. Nationally, accurate coding for dural CSF leak repairs matters for quality tracking of postoperative complications, appropriate surgical reimbursement, and alignment of clinical documentation with operative technique.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides clinical context for when 61619 is reported, benchmarks for utilization where available, common billing considerations, and policy updates affecting coverage and documentation. Readers will learn how the code maps to neurosurgical service lines, typical sites of service, common modifiers used in practice (listed separately), and practical documentation elements that support reporting the procedure. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare61619CPTneurosurgerydural-repaircraniotomycerebrospinal-fluidoperative-procedurehospital-surgery

Billing Code Overview

CPT code 61619 describes a surgical procedure to repair a cerebrospinal fluid (CSF) leak in the dura mater using a pedicle flap after a craniotomy. This procedure addresses persistent or postoperative CSF leakage by creating a vascularized dural repair with a pedicle flap to re-establish dural integrity.

Service type: Neurosurgical dura repair using a pedicle flap (operative procedure)
Typical site of service: Inpatient or outpatient hospital setting, operating room during or following craniotomy

Clinical & Coding Specifications

Clinical Context

A middle-aged patient presents post-craniotomy with persistent clear, watery drainage from the surgical incision and symptoms consistent with intracranial hypotension such as positional headache and nausea. Imaging (CT cisternography or MR myelography) localizes a dural cerebrospinal fluid (CSF) leak adjacent to the prior craniotomy site. The neurosurgery team schedules an operative repair using a pedicle flap to close the dural defect and re-establish a watertight barrier.

Preoperative workflow includes history and physical, imaging confirmation of CSF leak, anesthesia evaluation, and informed consent documenting the need for dural repair after craniotomy. Intraoperative steps include re-exposure of the prior craniotomy site, identification of the dural defect, harvesting and mobilization of a vascularized pedicle flap (pericranial, temporalis, or galeal flap depending on location), secure suturing or grafting to seal the leak, Valsalva testing to confirm repair integrity, and closure of the cranial incision. Postoperative management includes head elevation, monitoring for recurrent leak or infection, possible lumbar drain management if placed, pain control, and follow-up imaging as indicated.

Coding Specifications

Modifier	Description	When to Use
`62`	Two surgeons	When two surgeons of different specialties work together as primary surgeons during the repair.

Taxonomy Code	Specialty	Notes
2084P0800X	Neurosurgery	Primary specialty performing cranial dural repairs.
207L00000X	Neurological Surgery	Alternate taxonomy label for neurosurgeons performing this procedure.
363LP0800X	Otolaryngology	Otolaryngologists may perform skull base dural repairs when leak involves sinonasal or skull base approaches.
208000000X	Surgery	General or craniofacial surgeons involved in complex cranial reconstruction adjuncts.
208VP0000X	Plastic and Reconstructive Surgery	May assist with soft tissue or flap reconstruction for complex scalp or pericranial pedicle flaps.

ICD-10 Code	Description	Clinical Relevance
`G97.3`	Postprocedural cerebrospinal fluid leak	Directly describes CSF leakage following a surgical procedure such as craniotomy and is a primary indication for this repair.
`G97.8`	Other postprocedural nervous system disorders	Used for other localized neurologic complications after surgery that may include dural defects or CSF-related sequelae.
`S06.5X9A`	Traumatic subdural hemorrhage with loss of consciousness of unspecified duration, initial encounter	Patients with prior cranial surgery after trauma may develop dural defects; this code may be present in the history list when relevant.
`I60.9`	Subarachnoid hemorrhage, unspecified	Prior hemorrhage requiring craniotomy can be part of the clinical history that led to subsequent postoperative CSF leak.
`T81.31XA`	Disruption of external operation (wound)	Can be used when wound dehiscence contributes to CSF leak after craniotomy and requires repair.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61619`	Repair of postoperative cerebrospinal fluid leak; with pedicle flap	Primary procedure code describing dural CSF leak repair using a pedicle flap after craniotomy.
`61520`	Craniectomy or craniotomy for excision of lesion, extradural; less than one hour	May represent the initial craniotomy procedure that preceded the postoperative CSF leak requiring repair.
`61618`	Repair of postoperative cerebrospinal fluid leak; without pedicle flap	Alternate repair technique when dural defect is closed without use of a pedicle flap; useful for code selection when flap not used.
`62270`	Spinal puncture, lumbar, diagnostic (eg, CSF) — not typically used in cranium but may be billed if diagnostic lumbar CSF sampling was performed preoperatively	May be performed pre- or postoperatively to evaluate CSF pressure or chemistry when intracranial hypotension is suspected.
`62272`	Spinal puncture, therapeutic (eg, intrathecal injection), lumbar	May be used if lumbar drainage is placed perioperatively to lower CSF pressure and protect repair.
`69990`	Microscopic surgical technique, requiring use of an operating microscope (list separately in addition to code for primary procedure)	Reported when an operating microscope is used during the dural repair and separate reporting is allowed by payer.

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