CPT® Code 0169T | Case2Code

Official Description

Stereotactic placement of infusion catheter(s) in the brain for delivery of therapeutic agent(s), including computerized stereotactic planning and burr hole(s)

Common Language Description

The procedure described by CPT® Code 0169T involves the stereotactic placement of infusion catheters in the brain, which facilitates the delivery of therapeutic agents directly to targeted areas within the central nervous system. This method is particularly advantageous due to the presence of the blood-brain barrier (BBB), a selective permeability barrier that restricts the passage of many pharmaceutical agents from the bloodstream into the brain. By utilizing a stereotactic approach, healthcare professionals can precisely navigate to specific brain regions, ensuring that therapeutic agents are administered effectively. The procedure begins with advanced imaging techniques, such as MRI or CT scans, which are employed to visualize the brain and assist in the meticulous planning of catheter placement. Surgical planning software is utilized to create a detailed algorithm that guides the placement of burr holes and catheters. During the procedure, an incision is made in the scalp to access the skull, and an air-powered drill is used to create burr holes through which the catheters are inserted. These catheters are then carefully threaded into the brain, guided by real-time imaging, and secured in place. Once the catheters are positioned, the scalp is closed around them, and the infusion of therapeutic agents begins. This technique is particularly beneficial for treating various conditions, including tumors and neurodegenerative diseases such as progressive multifocal leukoencephalopathy, Gaucher's disease, and Parkinson's disease, as well as neurological disorders like epilepsy. The ability to deliver drugs directly to the brain enhances their efficacy and minimizes systemic side effects, making this procedure a critical option in the management of complex neurological conditions.

1. Indications

The stereotactic placement of infusion catheters in the brain is indicated for several specific conditions and therapeutic needs. These include:

Tumors - The procedure is utilized to deliver therapeutic agents directly to brain tumors, enhancing treatment efficacy.
Neurodegenerative Diseases - Conditions such as progressive multifocal leukoencephalopathy, Gaucher's disease, and Parkinson's disease may benefit from direct drug delivery to affected brain areas.
Neurological Conditions - The procedure is also indicated for managing epilepsy and other neurological disorders that require targeted treatment.

2. Procedure

The procedure for stereotactic placement of infusion catheters involves several critical steps to ensure precision and safety.

Step 1: Imaging and Planning - The process begins with advanced imaging techniques, such as MRI or CT scans, to visualize the brain. Surgical planning software is then employed to create a detailed algorithm that maps out the optimal placement of burr holes and catheters, ensuring accurate targeting of the therapeutic delivery site.
Step 2: Scalp Incision - Once the planning is complete, a surgical incision is made in the scalp to expose the underlying skull. This step is crucial for accessing the brain safely.
Step 3: Burr Hole Creation - An air-powered drill is utilized to create burr holes in the skull. These holes serve as entry points for the infusion catheters, allowing for direct access to the brain tissue.
Step 4: Catheter Insertion - The infusion catheters are carefully threaded through the burr holes and guided into the brain. This step is performed under real-time imaging to ensure accurate placement within the targeted area.
Step 5: Securing Catheters - Once the catheters are positioned correctly, they are secured in place to prevent movement during the infusion process.
Step 6: Scalp Closure - After securing the catheters, the scalp is closed around them, ensuring that the entry points are protected.
Step 7: Infusion Commencement - Following the closure, the infusion of therapeutic agents begins, allowing for continuous micro-infusion directly into the brain.
Step 8: Catheter Removal - Upon completion of the treatment, the catheters are removed, concluding the procedure.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications related to the surgical intervention and the infusion process. Patients may require follow-up imaging to assess the effectiveness of the treatment and to ensure that there are no adverse effects from the catheter placement. Additionally, healthcare providers will evaluate the patient's response to the therapeutic agents administered and make any necessary adjustments to the treatment plan. It is essential to provide instructions regarding care at the incision site and to monitor for signs of infection or other complications. The overall recovery process will vary depending on the individual patient's condition and the specific therapeutic agents used.

Short Descr	PLACE STEREO CATH BRAIN
Medium Descr	STEREOTACTIC PLACEMENT CATHETER BRAIN
Long Descr	Stereotactic placement of infusion catheter(s) in the brain for delivery of therapeutic agent(s), including computerized stereotactic planning and burr hole(s)
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	9 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - 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	Not applicable/unspecified.
CCS Clinical Classification	2 - Insertion, replacement, or removal of extracranial ventricular shunt