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The procedure described by CPT® Code 20660 involves the application of cranial tongs, a caliper, or a stereotactic frame, which are devices used to stabilize the cervical spine during medical treatment. This stabilization is crucial for patients who may require precise positioning of the head and neck, particularly in surgical or diagnostic settings. The process begins with the application of local anesthesia to ensure patient comfort. Prior to the placement of the device, the physician prepares the skin by shaving the areas where the pins will be inserted and applying an antiseptic solution, such as Betadine, to minimize the risk of infection. The cranial device is then secured by advancing pins into the cranial skin, ensuring that the skull is not penetrated, which is a critical aspect of the procedure to avoid complications. The stability of the device is maintained by tightening lock nuts, which are regularly checked to ensure they remain secure throughout the duration of use. Importantly, this code also encompasses the removal of the cranial device, indicating that both the application and removal are considered part of the same procedural service.
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The application of cranial tongs, caliper, or stereotactic frame is indicated for various clinical scenarios where stabilization of the cervical spine is necessary. This procedure is typically performed in the following situations:
The procedure for applying cranial tongs, caliper, or stereotactic frame involves several critical steps to ensure proper stabilization of the cervical spine. The first step is the administration of local anesthesia to the patient, which is essential for minimizing discomfort during the procedure. Following this, the physician prepares the skin by shaving the areas where the pins will be placed. This preparation is crucial for maintaining a sterile environment and reducing the risk of infection. After shaving, an antiseptic solution, such as Betadine, is applied to the skin to further enhance sterility.
Once the skin is prepared, the physician proceeds to place the cranial device. This involves advancing the pins from the device into the cranial skin, ensuring that the skull is not pierced. This technique is vital as it helps to avoid complications associated with penetrating the skull. After the pins are positioned, lock nuts are tightened to secure the device in place, maintaining the appropriate depth and stability. The physician must regularly check these lock nuts every few hours to ensure that the device remains stable and secure throughout its use. Finally, the procedure also includes the removal of the cranial device, which is performed once the stabilization is no longer required, completing the service associated with this CPT® code.
After the application of cranial tongs, caliper, or stereotactic frame, post-procedure care is essential to ensure patient safety and comfort. The physician or medical staff will monitor the stability of the device and the patient's condition regularly. It is important to observe for any signs of discomfort, infection, or complications related to the pin sites. Once the stabilization is no longer needed, the device is carefully removed, and the pin sites are assessed for any signs of irritation or infection. Patients may be advised on follow-up care, including any necessary restrictions on movement or activity to promote healing and prevent complications.
| Short Descr | APPLY REM FIXATION DEVICE | Medium Descr | APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX | Long Descr | Application of cranial tongs, caliper, or stereotactic frame, including removal (separate procedure) | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | 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 | T-Packaged Codes | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5B - Ambulatory procedures - musculoskeletal | MUE | 1 | CCS Clinical Classification | 214 - Traction, splints, and other wound care |
| 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. | 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). | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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). | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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.) | 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | ET | Emergency services | F1 | Left hand, second digit | F2 | Left hand, third digit | F5 | Right hand, thumb | F6 | Right hand, second digit | F7 | Right hand, third digit | F8 | Right hand, fourth digit | FA | Left hand, thumb | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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) | T1 | Left foot, second digit | T6 | Right foot, second digit | 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 | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |
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