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The CPT® Code 61536 refers to a surgical procedure known as a craniotomy with elevation of the bone flap, specifically performed for the excision of a cerebral epileptogenic focus. This procedure is characterized by the inclusion of electrocorticography during surgery, which is a technique used to monitor electrical activity in the brain. The process begins with the reopening of a previously made surgical site, where an electrode array may have been placed to identify the source of epileptic seizures. The removal of this electrode array is a critical step, as it allows for direct access to the brain tissue that needs to be evaluated and potentially excised. The procedure involves making a skin incision along the original incision lines, raising scalp flaps, and elevating a bone flap to access the underlying brain. Depending on the type of electrode array used—either epidural or subdural—the appropriate removal technique is employed. Following the removal of the electrode array, electrocorticography is performed by placing electrodes on the surface of the cerebral cortex and, if necessary, deeper into the brain. This allows for the recording of brain wave activity, which aids in identifying the boundaries of the epileptogenic focus. Once the abnormal brain tissue is located, it is excised, and the procedure concludes with the careful closure of the dura, replacement of the bone flap, and layered closure of the scalp. This comprehensive approach ensures that the epileptogenic focus is effectively addressed while minimizing potential complications associated with the surgery.
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The procedure described by CPT® Code 61536 is indicated for patients who have undergone prior surgeries involving the placement of an epidural or subdural electrode array for the identification of an epileptogenic focus. The specific indications for performing this craniotomy include:
The procedure for CPT® Code 61536 involves several critical steps, each designed to ensure the safe and effective excision of the epileptogenic focus. The steps are as follows:
Post-procedure care following a craniotomy with elevation of the bone flap for the excision of a cerebral epileptogenic focus includes monitoring for any complications such as infection, bleeding, or neurological deficits. Patients are typically observed in a recovery area before being transferred to a hospital room for further monitoring. Pain management is an essential aspect of post-operative care, and patients may require medications to manage discomfort. Follow-up appointments are necessary to assess the surgical site, monitor recovery, and evaluate the effectiveness of the procedure in reducing seizure activity. Rehabilitation services may also be recommended to support the patient's recovery and address any cognitive or physical challenges that may arise following surgery.
| Short Descr | REMOVAL OF BRAIN LESION | Medium Descr | CRANIOT EPILEPTOGENIC FOCUS W/ELECTROCORTCOGRPHY | Long Descr | Craniotomy with elevation of bone flap; for excision of cerebral epileptogenic focus, with electrocorticography during surgery (includes removal of electrode array) | 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. | 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. | 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). | 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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| Pre-1990 | Added | Code added. |
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