© Copyright 2025 American Medical Association. All rights reserved.
A twist drill hole is a surgical procedure performed to access the subdural space or the ventricles of the brain. This procedure involves the use of a hand twist drill, which is specifically designed to create a small opening in the skull. The drill is equipped with a safety stop that is adjusted to the anticipated thickness of the skull at the site where the hole will be made. As the drill penetrates the outer and inner tables of the skull, the surgeon monitors for a change in resistance, which indicates that the inner table has been breached and the dura mater, the protective membrane surrounding the brain, has been punctured. Following this, a needle is inserted through the newly created drill hole to access the subdural space or one of the brain's ventricles, allowing for the aspiration of cerebrospinal fluid (CSF). This procedure is critical for diagnostic purposes, such as analyzing CSF for infections or other neurological conditions. It is important to note that if the procedure involves the implantation of an intraventricular catheter or other monitoring devices, a different CPT® code, specifically 61107, should be utilized. This highlights the distinction between a simple puncture and more complex interventions that require additional equipment for monitoring intracerebral parameters.
© Copyright 2025 Coding Ahead. All rights reserved.
Twist drill hole procedures are indicated for various clinical scenarios where access to the subdural space or brain ventricles is necessary. The following conditions may warrant the performance of this procedure:
The procedure for creating a twist drill hole involves several critical steps to ensure proper access and minimize complications. The following outlines the procedural steps:
After the twist drill hole procedure, the patient is monitored for any signs of complications, such as infection or bleeding. The site of the drill hole is typically closed with a sterile dressing. Patients may require further imaging studies or monitoring, depending on the underlying condition that necessitated the procedure. Recovery time can vary based on the patient's overall health and the complexity of the underlying issue addressed during the procedure. Follow-up care may include neurological assessments to ensure that there are no adverse effects from the procedure.
| Short Descr | TDH SDRL/VENTR PNXR | Medium Descr | TWIST DRILL HOLE SUBDURAL/VENTRICULAR PUNCTURE | Long Descr | Twist drill hole for subdural or ventricular puncture | 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) | 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 | 1 | CCS Clinical Classification | 1 - Incision and excision of CNS |
| 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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 |
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| 2025-01-01 | Changed | Short Description changed. |
| 2007-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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