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The CPT® Code 61538 refers to a surgical procedure known as craniotomy with elevation of the bone flap specifically for the purpose of performing a lobectomy of the temporal lobe, accompanied by electrocorticography during the surgery. This procedure is primarily indicated for patients suffering from epilepsy, where the excision of one of the temporal lobes is performed to help control epileptic seizures. The temporal lobectomy may be executed with or without the use of intraoperative electrocorticography, which is a technique that involves the direct recording of electrical potentials from the cerebral cortex and surrounding structures. This recording aids in identifying the boundaries of the epileptogenic zone, which is crucial for determining the extent of the necessary resection of the temporal lobe. During the procedure, the surgeon makes an incision in the skin and creates scalp flaps, followed by the drilling of burr holes in the skull. The bone between these burr holes is then cut using a specialized saw or craniotome, allowing the elevation of the bone flap. Once the dura mater, the protective covering of the brain, is opened and retracted, the surgeon measures the anterior aspect of the temporal lobe to plan the cortical incisions. If electrocorticography is utilized, electrodes are placed on the cerebral cortex's surface, and additional electrodes may be inserted into deeper brain regions to record brain activity, both with and without stimuli. This information is vital for accurately identifying the epileptogenic zone's boundaries. The surgical process continues with the incision of the cortex and dissection deep into the brain using an ultrasonic aspirator. The dissection proceeds along the coronal plane towards the temporal horn of the lateral ventricle and the hippocampus. The surgeon then focuses on the pia mater of the medial cortex, performing a subpial dissection and opening the pia. The anterior and lateral portions of the temporal lobe are excised, followed by careful dissection of the hippocampus, amygdala, and uncus. Throughout the procedure, meticulous care is taken to coagulate and divide perforating arteries from the posterior cerebral artery while preserving critical structures such as the anterior choroidal artery and the pia arachnoid over the ambient cistern, which contains vital neurovascular elements. The excision of the temporal lobe is completed with the removal of the hippocampus, amygdala, and uncus. Finally, the dura is repaired, the bone flap is replaced and secured, and the temporalis muscle is repaired before closing the galea and skin in layers. This comprehensive approach ensures that the procedure is performed with precision and care, addressing the patient's condition effectively.
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The procedure described by CPT® Code 61538 is indicated for the following conditions:
The procedure begins with the patient being positioned appropriately, followed by the administration of anesthesia. The surgeon makes a skin incision and creates scalp flaps to expose the underlying skull. Burr holes are drilled into the skull, and the bone between these holes is cut using a craniotome or saw. This allows for the elevation of the bone flap, providing access to the brain beneath. Once the bone flap is elevated, the dura mater, which is the outermost layer of the protective covering of the brain, is opened and retracted to expose the cerebral cortex.
Post-procedure care involves monitoring the patient in a recovery area for any immediate complications. Patients may require pain management and close observation for neurological status. Follow-up imaging may be necessary to assess the surgical site and ensure there are no complications such as bleeding or infection. Rehabilitation services may also be recommended to support recovery and address any cognitive or physical deficits resulting from the surgery. The overall recovery time can vary based on individual patient factors and the extent of the surgery performed.
| Short Descr | REMOVAL OF BRAIN TISSUE | Medium Descr | CRANIOT LOBEC TEMPORAL LOBE W/ELECTROCORTCOGRPHY | Long Descr | Craniotomy with elevation of bone flap; for lobectomy, temporal lobe, with 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. | 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient 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. | 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). | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2004-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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