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The CPT® Code 61539 refers to a surgical procedure known as craniotomy with elevation of the bone flap, specifically for lobectomy of a lobe other than the temporal lobe. This procedure is performed either partially or totally and incorporates the use of electrocorticography during the surgery. Electrocorticography, often referred to as brain mapping, is a technique that involves the direct recording of electrical potentials from the cerebral cortex and surrounding structures. This method is crucial for identifying the boundaries of the epileptogenic zone, which is the area of the brain responsible for generating epileptic seizures, and for determining the extent of the necessary resection of the affected lobe. The procedure begins with an incision in the skin and the creation of 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 surgeon to elevate 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 lobe to be excised and determines the locations for cortical incisions. If electrocorticography is utilized, electrodes are placed on the surface of the cerebral cortex, and additional electrodes may be inserted into deeper brain regions to record brain activity, both with and without stimuli. The surgical team carefully identifies the epileptogenic zone, incises the cortex, and performs dissection deep to the cortex using an ultrasonic aspirator. The dissection continues along the coronal plane towards the temporal horn of the lateral ventricle and the hippocampus. Special attention is given to the pia mater of the medial cortex, where a subpial dissection is performed, and the pia is opened. The anterior and lateral portions of the lobe are excised, followed by careful dissection of the hippocampus, amygdala, and uncus, ensuring that perforating arteries from the posterior cerebral artery are preserved. Throughout the procedure, the surgeon takes care to protect critical structures, including the anterior choroidal artery and the pia arachnoid over the ambient cistern, which contains vital neurovascular elements. The procedure concludes with the repair of the dura, replacement and securing of the bone flap, and closure of the temporalis muscle, galea, and skin in layers. This comprehensive approach ensures that the lobectomy is performed safely and effectively, with the goal of alleviating the patient's symptoms.
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The procedure described by CPT® Code 61539 is indicated for the surgical removal of a lobe of the brain, other than the temporal lobe, in patients who may be experiencing severe neurological conditions, particularly those related to epilepsy. The specific indications for this procedure include:
The procedure for CPT® Code 61539 involves several detailed steps, which are as follows:
Post-procedure care following a lobectomy using CPT® Code 61539 involves monitoring the patient for any complications, such as infection, bleeding, or neurological deficits. Patients are typically observed in a recovery area until they are stable. Pain management is provided as needed, and neurological assessments are conducted to evaluate the patient's recovery. Follow-up appointments are essential to monitor the patient's progress and to assess the effectiveness of the surgery in controlling seizures. Rehabilitation services, including physical, occupational, or speech therapy, may be recommended based on the patient's individual needs and recovery trajectory.
| Short Descr | REMOVAL OF BRAIN TISSUE | Medium Descr | CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/ECOG | Long Descr | Craniotomy with elevation of bone flap; for lobectomy, other than temporal lobe, partial or total, 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) |
| 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). | 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.) | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2004-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |