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The procedure described by CPT® Code 0398T involves a non-invasive technique known as Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS). This advanced method is utilized for the stereotactic ablation of intracranial lesions, specifically targeting movement disorders such as essential tremor and Parkinson’s disease. The process begins with the preparation of the patient's scalp, which includes shaving the hair and inspecting the area for any scars or lesions that may interfere with the transmission of ultrasound waves. To facilitate precise targeting, four pins are inserted into the scalp, and a stereotactic frame is affixed low on the head, ensuring that the brain is accurately positioned within the treatment window. A silicone membrane is then placed over the scalp, which is filled with cool, degassed water at approximately 18°C. This cooling mechanism is crucial as it protects the external tissues and bone from potential burns caused by the ultrasound waves. The patient is positioned on the MRI table, and a specialized helmet containing the ultrasound transducer is secured over the silicone membrane, as well as the frame, to the MRI machine. Comprehensive MRI sequences are conducted to capture images of the entire brain and the specific target areas for treatment. These images, along with the treatment plan, are meticulously reviewed by the surgeon to ensure accuracy and effectiveness. A software program is employed to calculate the necessary treatment parameters, and the procedure commences with the generation of focused ultrasound energy from the helmet transducer, which creates a process known as sonication. Throughout the procedure, Magnetic Resonance Thermometry Imaging is utilized to provide real-time temperature maps, allowing for continuous monitoring to confirm that the lesions are being adequately treated. Notably, the patient remains awake during the entire process, enabling them to provide clinical feedback to the surgeon. Upon completion of the procedure, the patient is carefully uncoupled from the helmet and frame and subsequently removed from the MRI scanner. It is important to note that CPT® Code 0398T encompasses the stereotactic navigation and frame placement associated with the MRgFUS intracranial lesion ablation when these components are performed.
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The procedure described by CPT® Code 0398T is indicated for the treatment of specific movement disorders. These include:
The MRgFUS procedure involves several critical steps to ensure effective treatment of the targeted intracranial lesions. The first step is the preparation of the patient, which includes shaving the hair on the scalp and inspecting the area for any scars or lesions that could interfere with the ultrasound waves. Following this, four pins are carefully placed into the scalp to secure a stereotactic frame, which is attached low on the head. This frame is essential for accurately centering the brain within the treatment window, allowing for precise targeting of the lesions.
Next, a silicone membrane is positioned over the scalp, and this membrane is filled with cool, degassed water that is chilled to approximately 18°C. This cooling is vital as it prevents burns to the external tissues and bone from the ultrasound waves generated during the procedure. The patient is then placed on the MRI table, and a specialized helmet containing the ultrasound transducer is placed over the silicone membrane. The frame and transducer are secured to the MRI machine to maintain stability throughout the procedure.
Once the patient is positioned correctly, MRI sequences are obtained to capture detailed images of the entire brain and the specific target areas for treatment. These images are reviewed by the surgeon, who assesses the treatment plan. A software program is utilized to calculate the necessary treatment parameters based on the imaging data. The treatment begins with the generation of focused ultrasound energy from the helmet transducer, which creates a process known as sonication, targeting the lesions for ablation.
During the procedure, Magnetic Resonance Thermometry Imaging is employed to provide real-time temperature maps, ensuring that the lesions are being adequately treated. The patient remains awake throughout the process, allowing them to provide clinical feedback to the surgeon regarding their experience and any sensations felt during the treatment. Upon completion of the procedure, the patient is carefully uncoupled from the helmet and frame, and then removed from the MRI scanner, concluding the MRgFUS treatment.
After the MRgFUS procedure, patients are typically monitored for any immediate post-operative effects. The non-invasive nature of the procedure generally allows for a quicker recovery compared to traditional surgical methods. Patients may experience some mild discomfort or transient side effects, which should be assessed by the healthcare team. Follow-up appointments are usually scheduled to evaluate the effectiveness of the treatment and to monitor for any potential complications. It is essential for patients to adhere to any post-procedure care instructions provided by their healthcare provider to ensure optimal recovery and outcomes.
| Short Descr | MRGFUS STRTCTC LES ABLTJ | Medium Descr | MRGFUS STEREOTACTIC ABLATION LESION INTRACRANIAL | Long Descr | Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation lesion, intracranial for movement disorder including stereotactic navigation and frame placement when performed | Status Code | Carriers Price the Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 4 - Special payment adjustment rules on the technical component (TC) of multiple diagnostic imaging 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) | 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 | 88 - | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | Berenson-Eggers TOS (BETOS) | I2D - Advanced imaging - MRI/MRA: other | MUE | Not applicable/unspecified. |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | GC | This service has been performed in part by a resident under the direction of a teaching physician | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2024-12-31 | Deleted | Code Deleted. See 61715 |
| 2016-01-01 | Added | Added |
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