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A decompressive craniectomy or craniotomy is a surgical procedure aimed at alleviating increased intracranial pressure, known as intracranial hypertension. This procedure can be performed with or without duraplasty, which is a technique used to repair or augment the dura mater, the outermost layer of the protective covering of the brain. The primary goal of this intervention is to relieve pressure on the brain without the need for evacuation of any associated intraparenchymal hematoma, which is a collection of blood within the brain tissue itself, and without performing a lobectomy, which involves the removal of a portion of the brain. In a craniectomy, the surgeon creates scalp flaps and drills several burr holes in the skull. The bone between these holes is then cut using a specialized saw or craniotome, allowing for the removal of a bone flap, which can be either temporarily or permanently excised. Conversely, a craniotomy involves making an incision in the scalp and lifting both the scalp and the bone flaps to access the brain. During this procedure, the dura is opened, and if necessary, a duraplasty is performed to expand the dura mater, facilitating the decompression of the brain. This may involve the use of various graft materials, such as an autologous galeal flap graft, a cultured dermal graft, or a synthetic patch graft. To ensure the integrity of the cerebrospinal fluid barrier, the dura and/or the dural graft is meticulously sutured. A drain may be placed to manage any excess fluid. After the procedure, the bone flap is typically repositioned over the dura and secured with steel sutures. In some cases, if significant cerebral swelling is anticipated, the bone flap may be excised and preserved in an abdominal pocket or a bone bank until the swelling subsides. This procedure is critical in managing conditions that lead to elevated intracranial pressure, thereby protecting brain function and preventing further neurological damage.
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The decompressive craniectomy or craniotomy procedure is indicated for the treatment of intracranial hypertension. This condition may arise from various underlying issues that lead to increased pressure within the skull, necessitating surgical intervention to prevent potential brain damage. The specific indications for this procedure include:
The procedure involves several critical steps to ensure effective decompression of the brain. The detailed procedural steps are as follows:
Post-procedure care is essential for ensuring proper recovery and monitoring for any complications. After the decompressive craniectomy or craniotomy, patients are typically observed in a critical care setting to monitor neurological status and intracranial pressure. Expected recovery may vary based on the individual patient's condition and the extent of the surgery performed. Additional considerations include managing pain, monitoring for signs of infection, and ensuring that any drains placed during the procedure are functioning correctly. Follow-up imaging may be required to assess the brain's condition and the effectiveness of the decompression. Rehabilitation may also be necessary to support recovery and address any neurological deficits that may arise following the procedure.
| Short Descr | CRNEC/CRNOT DCMPRV W/O LOBEC | Medium Descr | CRNEC/CRNOT DCMPRV W/WO DURAPLASTY W/O LOBECTOMY | Long Descr | Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; without lobectomy | 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | 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 |
This is a primary code that can be used with these additional add-on codes.
| 61316 | Addon Code MPFS Status: Active Code APC C Incision and subcutaneous placement of cranial bone graft (List separately in addition to code for primary procedure) | 69990 | Addon Code MPFS Status: Restricted APC N ASC N1 PUB 100 CPT Assistant Article 1Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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. | 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. | 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). | 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). | AG | Primary physician | CR | Catastrophe/disaster related | LT | Left side (used to identify procedures performed on the left side of the body) | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | 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 |
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| 2025-01-01 | Changed | Short and Medium Descriptions changed. |
| 2003-01-01 | Added | First appearance in code book in 2003. |
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