🧠 CPT 61315 — Craniectomy or Craniotomy for Evacuation of Hematoma, Infratentorial; Intracerebellar
Quick Reference
wRVU: 19.18 (verify) | Global Period: 090 | Assistant Payable: Yes | Bilateral Indicator: 0 Rule: This is a major neurosurgical procedure with a 90-day global surgical package, meaning all related E/M services for the 92-day window (1 day pre-op plus 90 days post-op) are bundled into the global fee. It is not bilateral-eligible since the cerebellum is a single midline structure, so modifier -50 never applies. Assistant surgeons are routinely used given the complexity and risk of posterior fossa access, so modifier -80/-82/-AS may be reported when supported by documentation.
📋 Clinical Description
CPT 61315 describes an open surgical procedure in which the surgeon removes a section of the occipital or suboccipital skull, either temporarily (craniotomy, bone flap replaced) or permanently (craniectomy, bone not replaced), to access the posterior fossa and evacuate a hematoma situated within the cerebellum itself, below the tentorium cerebelli. This infratentorial, intracerebellar location distinguishes 61315 from its sibling code 61314, which addresses an infratentorial hematoma in the extradural or subdural space rather than within the brain parenchyma. The surgeon decompresses the posterior fossa to relieve mass effect on the brainstem and fourth ventricle, a life-threatening complication given the limited space in this compartment.
The procedure is typically performed emergently or urgently because cerebellar hematomas carry a high risk of rapid neurological deterioration, brainstem compression, obstructive hydrocephalus, and herniation. Compared to the supratentorial codes 61312 and 61313, which address hematomas above the tentorium, 61315 requires a different surgical approach (typically a suboccipital craniectomy) and carries distinct anatomic risk given the proximity to the brainstem and cranial nerve nuclei.
This procedure may be performed in the following clinical contexts:
- Spontaneous (hypertensive) cerebellar hemorrhage — most often due to chronic hypertension causing rupture of small perforating arteries within the cerebellum, requiring urgent decompression once the hematoma reaches a size threatening brainstem compression.
- Traumatic cerebellar contusion/hemorrhage — following blunt occipital trauma, frequently from falls or motor vehicle collisions, with hematoma evolution monitored on serial imaging before surgical decision-making.
- Post-surgical hematoma — as a complication following posterior fossa surgery (e.g., tumor resection or Chiari decompression), requiring a return to the operating room for evacuation, often reported with modifier -78.
- Hemorrhagic conversion of cerebellar infarct — in select cases of large cerebellar strokes with secondary hemorrhagic transformation and mass effect.
- Vascular malformation rupture — such as a cavernous malformation or arteriovenous malformation located within the cerebellum, presenting with acute hemorrhage requiring decompression, sometimes followed by definitive lesion resection.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Suboccipital craniectomy approach | The surgeon makes a posterior midline or paramedian incision, removes suboccipital bone (craniectomy, not replaced), opens the dura, and evacuates the clot under microscopic or loupe magnification. | This is the most common approach for emergent decompression because it provides the fastest, most direct access to the posterior fossa and allows the bone to remain off if swelling is anticipated. |
| Craniotomy with bone flap replacement | A bone flap is cut, hinged or removed, the hematoma evacuated, and the flap is secured back in place with plates or sutures at closure. | Reserved for more controlled, less emergent cases where significant post-operative cerebellar swelling is not anticipated, since replacing the flap avoids a second cranioplasty procedure later. |
| Combined decompression with EVD placement | In cases complicated by obstructive hydrocephalus from fourth ventricle compression, an external ventricular drain may be placed in the same setting. | The EVD placement (CPT 61210 or 61107, depending on technique) is generally separately reportable from 61315 when performed at a distinct cranial site, since it addresses a different clinical problem (CSF diversion) than hematoma evacuation. |
Clinical Pearl
The single most important documentation element for accurate use of 61315 is confirmation that the hematoma is intracerebellar (within the brain substance) rather than extra-axial (epidural or subdural) in the infratentorial compartment, since that distinction determines whether 61315 or 61314 is the correct code. Operative notes that simply state “posterior fossa hematoma evacuation” without specifying location relative to the cerebellar parenchyma should prompt a physician query before code assignment.
✅ Procedure Includes
- Positioning and prepping the patient, typically prone or lateral (park-bench) position, which requires significant additional intraoperative time compared to supratentorial cases.
- Suboccipital or posterior fossa craniectomy/craniotomy, including elevation of the bone flap or removal of bone.
- Durotomy and direct visualization of the cerebellum under the operating microscope.
- Evacuation of the intracerebellar hematoma with irrigation and hemostasis of the bleeding source.
- Closure of the dura, with or without a dural substitute or graft, and reapproximation of soft tissue layers.
- Standard wound closure of the suboccipital incision.
- Use of intraoperative neuronavigation, when documented, is generally considered part of the global package unless separately reportable add-on codes for computer-assisted navigation are used.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 61312 | Craniectomy/craniotomy for evacuation of hematoma, supratentorial; extradural or subdural | Distinct by both compartment (supratentorial vs. infratentorial) and hematoma location (extra-axial vs. intra-axial), so 61312 and 61315 are never reported together for the same lesion. |
| 61313 | Craniectomy/craniotomy for evacuation of hematoma, supratentorial; intracerebral | Shares the intraparenchymal hematoma concept with 61315 but differs by compartment; both would only be reported together if truly separate, distinct hematomas in separate locations were evacuated in the same session, which is uncommon and would require modifier -59/-XS with strong documentation. |
| 61314 | Craniectomy/craniotomy for evacuation of hematoma, infratentorial; extradural or subdural | The direct infratentorial counterpart distinguished only by hematoma location relative to brain tissue; coders should never default to one over the other without explicit operative documentation. |
| 61108 | Twist drill hole for subdural or intracerebral hematoma evacuation | A much less invasive, percutaneous approach; if a twist drill procedure is converted to an open craniectomy in the same session, only the more extensive open procedure (61315) is reported. |
Bundling Alert
Because 61315 carries a 90-day global period, any related post-operative E/M visits, dressing changes, or suture removals performed by the operating surgeon or same-group same-specialty partners within that window are bundled and not separately billable. A return trip to the OR for a recurrent hematoma within the global period requires modifier -78 (unplanned return for a related procedure), while a staged second-look procedure planned at the index surgery uses modifier -58. Audit risk is elevated when facilities attempt to separately bill burr holes, twist drill access, or skin-level hematoma drainage performed solely to reach the intracranial hematoma, since NCCI policy bundles this access work into 61315 itself.
🌳 Code Tree — Surgery: Skull, Meninges, and Brain
CPT 61000-62258 Surgery: Surgical Procedures on the Skull, Meninges, and Brain
│
├── 61105-61253 Twist Drill, Burr Hole(s), or Trephine Procedures
│ ├── 61108 Twist drill hole(s) for subdural/intracerebral hematoma evacuation
│ └── 61154 Burr hole(s) with evacuation/drainage of hematoma, extradural or subdural
│
├── 61304-61576 Craniectomy or Craniotomy Procedures
│ ├── 61312 Craniectomy/craniotomy for hematoma evacuation, supratentorial; extradural or subdural
│ ├── 61313 Craniectomy/craniotomy for hematoma evacuation, supratentorial; intracerebral
│ ├── 61314 Craniectomy/craniotomy for hematoma evacuation, infratentorial; extradural or subdural
│ ├── ▶▶ 61315 ◀◀ Craniectomy/craniotomy for hematoma evacuation, infratentorial; intracerebellar ← YOU ARE HERE (Global: 090)
│ ├── 61316 Reconstruction of cranial bone defect with synthetic material (List separately, add-on) (Global: ZZZ)
│ └── 61320 Craniectomy/craniotomy, drainage of intracranial abscess; supratentorial
│
└── 61534-61576 Craniotomy for Excision/Treatment of Lesions
├── 61500 Craniectomy with excision of tumor/lesion of skull
└── 61510 Craniectomy/craniotomy for excision of brain tumor, supratentorial, except meningioma
💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 19.18 (verify against current MPFS) |
| Global Period | 090 |
| Bilateral Indicator | 0 — Not applicable |
| Assistant Surgeon | Yes — payable with modifier 80/82/AS, supported by documentation of medical necessity |
| Co-Surgeon | Payable when two surgeons of different specialties each perform a distinct, medically necessary portion (modifier 62) |
| Team Surgery | Not typically applicable; rare exception in combined skull-base cases |
| PC/TC Split | 0 — Global surgical procedure, no separate professional/technical component split |
| Modifier -51 Exempt | No |
| Anesthesia | Reported separately by the anesthesiologist using the corresponding cranial anesthesia base code |
Bilateral Billing Rules
The cerebellum is a single midline structure, so 61315 is never reported with modifier -50 for bilateral procedures. If the surgeon documents a bilateral cerebellar hemorrhage requiring evacuation through separate approaches, this still represents a single procedure on a single organ, and additional payment is not supported by separately billing the code twice.
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -RT | Right Side | Generally not applicable since the cerebellum is a midline structure; use only if the operative note specifies a clearly lateralized cerebellar hemisphere approach for payer-specific reporting requirements. |
| -LT | Left Side | Same limitation as -RT; laterality modifiers are rarely required for this code given the midline target structure. |
| -50 | Bilateral | Not applicable to 61315, as explained in the Bilateral Billing Rules above. |
| -22 | Increased Procedural Services | Apply when the operative note clearly documents substantially increased time, technical difficulty, or complexity, such as a deeply embedded clot abutting the brainstem requiring extended dissection. |
| -25 | Significant E/M | Apply to a separately identifiable E/M service performed the same day, such as the initial neurosurgical consultation that drives the decision for emergent surgery, when documentation supports a distinct, significant service beyond the routine pre-operative work. |
| -51 | Multiple Procedures | Apply when 61315 is reported with another separately reportable, unrelated procedure in the same operative session, such as a distinct shunt placement. |
| -59 | Distinct Service | Apply only when a truly separate procedure, at a separate session or separate site, is performed and would otherwise appear bundled; document medical necessity clearly given high audit scrutiny on this modifier. |
| -62 | Two Surgeons | Apply when two surgeons of different specialties (e.g., neurosurgery and ENT for a combined approach) each perform a distinct portion of the procedure and each dictates an operative note. |
| -78 | Return to OR | Apply when the patient returns unplanned to the operating room within the 90-day global period for a complication directly related to the index surgery, such as a recurrent hematoma. |
| -80 | Assistant Surgeon | Apply when a second surgeon assists throughout the procedure without performing a distinct portion themselves; commonly used given the complexity of posterior fossa surgery. |
🩺 Common ICD-10-CM Pairings
Primary Diagnosis Group
| ICD-10 | Description | HCC? | Notes |
|---|---|---|---|
| I61.4 | Nontraumatic intracerebellar hemorrhage | Yes | This is the most common and most specific primary diagnosis paired with 61315, supporting medical necessity for an emergent decompressive evacuation. |
| S06.37XA | Traumatic hemorrhage of cerebellum, initial encounter | No | Used when the hematoma is clearly trauma-related, such as following a fall or motor vehicle collision; an associated external cause code should also be reported. |
Secondary Group
| ICD-10 | Description | HCC? | Notes |
|---|---|---|---|
| G93.6 | Cerebral edema | No | Frequently reported as a secondary diagnosis when the hematoma is accompanied by significant surrounding edema contributing to mass effect. |
| I10 | Essential (primary) hypertension | No | Commonly an underlying etiologic factor for spontaneous cerebellar hemorrhage and should be captured when documented as a contributing condition. |
Etiology / Complication
| ICD-10 | Description | HCC? | Notes |
|---|---|---|---|
| G91.4 | Hydrocephalus in diseases classified elsewhere | No | Reported when obstructive hydrocephalus develops secondary to fourth ventricle compression from the cerebellar hematoma. |
Coding Specificity Reminder
Always confirm whether the hemorrhage is documented as traumatic or nontraumatic before code assignment, since this distinction drives both the ICD-10-CM chapter selection and DRG grouping. For traumatic cases, an external cause code and encounter type character (A, D, S) must be appended. Avoid defaulting to an unspecified intracranial hemorrhage code when the operative and radiology documentation clearly identifies the cerebellum as the bleed site, since specificity directly supports both medical necessity and accurate severity-of-illness capture for DRG assignment.
🏥 MS-DRG Considerations
CPT 61315, when reported on the inpatient facility side, crosswalks to ICD-10-PCS codes that typically group to MS-DRGs within MDC 01 (Diseases and Disorders of the Nervous System), most often DRG 023 or 024 (Craniotomy with Major Device Implant or Acute Complex CNS Principal Diagnosis, with or without MCC) given the acuity of cerebellar hemorrhage cases. The presence of a documented MCC, such as acute respiratory failure or hydrocephalus requiring shunt placement, will shift the case into the higher-weighted DRG tier. Inpatient coders should ensure the principal diagnosis sequencing reflects the condition that occasioned the admission, typically the cerebellar hemorrhage itself, with hydrocephalus and other complications sequenced as secondary diagnoses when present. Because these cases frequently involve ICU-level care, careful capture of all secondary diagnoses and procedures, including ventilator management and ICP monitoring, materially affects DRG weight and reimbursement accuracy.
🔧 ICD-10-PCS Equivalents
| PCS Code | Full Description | Modality |
|---|---|---|
| 009U0ZZ | Extirpation of matter from cerebellum, open approach | Open surgical |
| 0W990ZZ | Drainage of posterior cranial fossa, open approach, no device | Open surgical |
| 00980ZZ | Drainage of cerebellum, open approach, no device | Open surgical |
| 00N00ZZ | Release of cerebral meninges, open approach | Open surgical |
PCS Character Analysis
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical section, covering the vast majority of operative procedures. |
| 2 | Body System | 0 | Central Nervous System and Cranial Nerves, encompassing the brain and its substructures. |
| 3 | Root Operation | 9 (Drainage) or D (Extirpation) | Drainage is used for evacuating fluid blood without solid clot removal; Extirpation is used when a solid clot is physically removed, which is the more typical scenario for 61315. |
| 4 | Body Part | U (Cerebellum) | Identifies the specific brain structure operated upon, distinguishing this from cerebral hemisphere codes. |
| 5 | Approach | 0 (Open) | Reflects the open craniectomy/craniotomy technique required to access the posterior fossa. |
| 6 | Device | Z (No Device) | No device is left in place for a straightforward hematoma evacuation. |
| 7 | Qualifier | Z (No Qualifier) | No additional qualifier applies to this procedure type. |
Root Operation Comparison
- Extirpation (root operation D) is generally the more accurate root operation when a discrete, formed clot is physically removed from the cerebellar parenchyma, as opposed to passive drainage of liquid blood.
- Drainage (root operation 9) would be appropriate if the procedure involved aspiration of liquefied blood without removal of a solid clot, which is less common in cerebellar hematoma evacuation.
- Coders should review the operative note language carefully, since the surgeon’s description of “evacuation,” “removal,” or “aspiration” directly informs root operation selection and downstream DRG assignment.
📝 Coding Examples
Example 1
Clinical Scenario: A 68-year-old male with a history of poorly controlled hypertension presents to the emergency department with sudden onset headache, vomiting, and decreasing level of consciousness. CT imaging reveals a 4 cm spontaneous intracerebellar hematoma with effacement of the fourth ventricle and early hydrocephalus. The neurosurgical team takes the patient emergently to the operating room for a suboccipital craniectomy with evacuation of the cerebellar hematoma. The hematoma is evacuated under microscopic visualization with good hemostasis achieved. The bone flap is removed and not replaced given anticipated post-operative swelling. The patient is transferred to the neuro-ICU post-operatively.
| Field | Code | Rationale |
|---|---|---|
| CPT | 61315 | Documentation clearly supports an open craniectomy with evacuation of an intracerebellar (intraparenchymal) hematoma, matching the descriptor precisely. |
| PDx | I61.4 | Nontraumatic intracerebellar hemorrhage is the documented underlying pathology driving the emergent surgical intervention. |
Note
This case should also capture hypertension as a secondary diagnosis and the associated hydrocephalus if it persists or requires separate intervention, since both materially affect DRG severity weighting.
Example 2
Clinical Scenario: A 45-year-old female sustains a fall down a flight of stairs with occipital impact. Initial CT shows a small cerebellar contusion; a repeat CT six hours later shows interval expansion of the hematoma with new mass effect on the brainstem. The patient is taken urgently for suboccipital craniectomy with evacuation of the hematoma. An external ventricular drain is placed in the same setting at a separate cranial entry site due to acute hydrocephalus.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 61107 | External ventricular drain placement through a separate burr hole is separately reportable since it addresses a distinct clinical problem (CSF diversion) at a different anatomic site. |
| CPT 2 | 61315 | The craniectomy with evacuation of the traumatic intracerebellar hematoma is the primary, most resource-intensive procedure of the encounter. |
| PDx | S06.37XA | Traumatic hemorrhage of cerebellum, initial encounter, reflects the documented mechanism and timing of injury. |
Warning
Modifier -59 or a more specific X{EPSU} modifier should be appended to the EVD placement code to clearly indicate it was performed at a separate site from the craniectomy, reducing denial risk under NCCI edits.
Example 3
Clinical Scenario: A patient undergoes 61315 for evacuation of a spontaneous cerebellar hemorrhage. On post-operative day 12, within the 90-day global period, the patient develops a new, unrelated subdural hematoma following a witnessed fall in the rehabilitation unit, requiring a second unrelated craniotomy.
| Field | Code | Rationale |
|---|---|---|
| CPT | 61312-79 | Modifier 79 indicates this second procedure is unrelated to the original surgery, occurring within the global period but addressing an entirely new problem, allowing separate payment. |
| PDx | S06.5X1A | Traumatic subdural hemorrhage with loss of consciousness reflects the new, unrelated injury prompting the second procedure. |
Global period reminder
⚠️ Common Coding Pitfalls
- Pitfall 1: Confusing 61315 with 61314 by failing to confirm whether the hematoma is truly intraparenchymal (intracerebellar) versus extra-axial (extradural/subdural) in the infratentorial space; this distinction must come directly from the operative report, not inferred from imaging alone.
- Pitfall 2: Separately billing burr hole or twist drill access codes used solely to reach the intracranial hematoma, when NCCI policy bundles this access work into the definitive open procedure code.
- Pitfall 3: Failing to append modifier -78 versus -79 correctly for return-to-OR scenarios within the 90-day global period, leading to either inappropriate denial or inappropriate full separate payment.
- Pitfall 4: Omitting the external cause code and encounter character when the underlying hemorrhage is traumatic, which can trigger claim edits or incomplete severity-of-illness capture on the facility side.
- Pitfall 5: Overlooking secondary diagnosis capture for hydrocephalus, cerebral edema, or hypertension, all of which can materially affect DRG weight and risk-adjustment accuracy if left uncoded.
- Pitfall 6: Defaulting to a less specific intracranial hemorrhage code when the documentation supports a fully specified cerebellar hemorrhage code, undermining both coding accuracy and HCC capture where applicable.
📎 Sources
1 2 3
AAPC Codify, CPT Code 61315 — Craniectomy or Craniotomy Procedures, accessed 2026. CMS National Correct Coding Initiative Policy Manual, Chapter VIII (Surgery: CPT Codes 60000-69999), revised 2026. UnitedHealthcare Community Plan Reimbursement Policy 2026R0038A, Microsurgery/CPT 69990 service list, 2026.