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Official Description

Craniotomy with elevation of bone flap; for excision of epileptogenic focus without electrocorticography during surgery

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 61534 refers to a craniotomy performed specifically for the excision of an epileptogenic focus, which is a localized area in the brain that generates epileptic seizures. This procedure is indicated for patients diagnosed with epilepsy where a specific lesion can be identified as the source of seizures. Prior to the surgery, diagnostic imaging techniques such as electroencephalography (EEG) and magnetic resonance imaging (MRI) are utilized to locate and confirm the presence of the epileptogenic focus. In cases where the lesion is situated outside of eloquent brain regions—areas responsible for critical functions such as movement, speech, and sensory processing—the surgery can proceed without the need for intraoperative electrocorticography, a technique that monitors brain activity during the procedure. The surgical process involves making an incision in the scalp, creating flaps, and using burr holes to access the skull. The bone is then cut and elevated to expose the dura mater, which is subsequently opened to allow access to the brain tissue. The abnormal tissue is carefully excised, and once the excision is complete, the dura is closed, the bone flap is replaced, and the scalp is sutured back in layers. This procedure aims to alleviate seizure activity by removing the source of the seizures, thereby improving the patient's quality of life.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 61534 is indicated for patients with epilepsy who have a clearly identifiable lesional or localized epileptogenic focus. The following conditions may warrant this surgical intervention:

  • Localized Epileptogenic Focus The presence of a specific lesion in the brain that has been confirmed through diagnostic imaging techniques such as electroencephalography (EEG) and magnetic resonance imaging (MRI).
  • Non-Eloquent Brain Region The lesion is located outside of eloquent areas of the brain, which are critical for essential functions such as movement, speech, and sensory processing, allowing for safe excision without significant risk of functional impairment.

2. Procedure

The procedure for CPT® Code 61534 involves several critical steps to ensure the successful excision of the epileptogenic focus:

  • Step 1: Incision and Flap Creation The surgical process begins with an incision made in the scalp, followed by the creation of scalp flaps to provide access to the underlying skull. This step is crucial for exposing the area where the craniotomy will be performed.
  • Step 2: Burr Holes and Bone Flap Elevation Burr holes are drilled into the skull to facilitate the cutting of the bone. A craniotome or saw is then used to cut the bone between these burr holes, allowing for the elevation of a bone flap. This step is essential for accessing the dura mater and the brain tissue beneath.
  • Step 3: Dura Opening and Retraction Once the bone flap is elevated, the dura mater, which is the protective covering of the brain, is opened and retracted. This provides direct access to the brain tissue where the epileptogenic focus is located.
  • Step 4: Identification and Excision of Abnormal Tissue The surgeon identifies the region of the lesional or localized epileptogenic focus and excises the abnormal brain tissue. This step is critical for removing the source of seizures and is performed with precision to minimize damage to surrounding healthy brain tissue.
  • Step 5: Closure of Dura and Bone Flap Replacement After the excision of the abnormal tissue, the dura is closed to protect the brain. The previously elevated bone flap is then replaced and secured in position using sutures, wires, or miniplates and screws to ensure stability.
  • Step 6: Layered Closure of Scalp Finally, the overlying muscle is repaired, and the galea and skin are closed in layers. This step is important for proper healing and cosmetic appearance post-surgery.

3. Post-Procedure

Post-procedure care following a craniotomy for the excision of an epileptogenic focus includes monitoring the patient for any signs of complications such as infection, bleeding, or neurological deficits. Patients may require pain management and will be observed in a recovery area before being transferred to a hospital room. Rehabilitation may be necessary to support recovery, and follow-up appointments will be scheduled to assess the surgical outcome and manage any ongoing seizure activity. The expected recovery time can vary based on individual patient factors and the extent of the surgery performed.

Short Descr REMOVAL OF BRAIN LESION
Medium Descr CRANIOT EPILEPTOGENIC FOC W/O ELECTRCORTICOGRPHY
Long Descr Craniotomy with elevation of bone flap; for excision of epileptogenic focus without electrocorticography during surgery
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.

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)
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.
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.
GC This service has been performed in part by a resident under the direction of a teaching physician
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