© Copyright 2025 American Medical Association. All rights reserved.
A twist drill hole is a surgical procedure that involves creating an opening in the skull to facilitate the evacuation of a subdural hematoma. This procedure is performed using a specialized hand twist drill, which is designed to penetrate the skull safely. The drill is equipped with a safety stop that is adjusted to the anticipated thickness of the skull at the specific site of the procedure. As the drill is advanced, it passes through the outer and inner tables of the skull. The operator monitors for a change in resistance, which indicates that the inner table has been successfully penetrated and the dura mater, the protective membrane surrounding the brain, has been punctured. Once the dura is breached, a syringe is inserted through the newly created drill hole into the subdural space, allowing for the flushing out of the subdural hematoma, which is a collection of blood that can exert pressure on the brain and lead to serious complications if not addressed promptly. This procedure is critical in managing conditions that arise from the accumulation of blood in the subdural space, thereby alleviating pressure and preventing further neurological damage.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure of creating a twist drill hole is indicated for specific medical conditions that necessitate the evacuation of blood from the subdural space. The following are the primary indications for this procedure:
The procedure for creating a twist drill hole involves several critical steps that ensure the safe and effective evacuation of a subdural hematoma. The following outlines the procedural steps:
Post-procedure care is essential to ensure proper recovery and monitoring of the patient. After the twist drill procedure, the patient is typically observed for any signs of complications, such as infection or re-accumulation of blood. Neurological status is closely monitored to assess for any changes that may indicate increased intracranial pressure or other complications. Depending on the extent of the procedure and the patient's condition, further imaging studies may be performed to evaluate the effectiveness of the hematoma evacuation. The patient may require additional interventions or supportive care based on their recovery progress and overall health status.
| Short Descr | TDH PNXR EVAC&/DRG SDRL HMTA | Medium Descr | TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA | Long Descr | Twist drill hole(s) for subdural, intracerebral, or ventricular puncture; for evacuation and/or drainage of subdural hematoma | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 1 - Incision and excision of CNS |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RT | Right side (used to identify procedures performed on the right side of the body) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2025-01-01 | Changed | Short Description changed. |
| 2007-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
Get instant expert-level medical coding assistance.