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The procedure described by CPT® Code 61541 involves a craniotomy with elevation of a bone flap specifically for the transection of the corpus callosum. The corpus callosum is a critical structure in the brain that connects the right and left cerebral hemispheres, facilitating communication between them. In this procedure, the corpus callosum is surgically divided to address generalized seizure disorders, which are characterized by seizures that originate in the cerebral cortex and can spread across the brain through the commissural pathways. By transecting the corpus callosum, the procedure aims to interrupt these pathways, potentially reducing or eliminating the occurrence of certain types of seizures. The surgical approach begins with a long incision on the scalp, followed by the creation of a scalp flap and the drilling of burr holes in the skull. The bone flap is then elevated to provide access to the brain, allowing for careful dissection and division of the callosal fibers while protecting surrounding structures. This intricate procedure requires precision and is typically performed under the guidance of a surgical microscope to ensure optimal outcomes.
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The procedure is indicated for the treatment of generalized seizure disorders, which are characterized by seizures that begin in the cerebral cortex and can spread through the commissural pathways. The transection of the corpus callosum is performed to interrupt these pathways, thereby reducing or eliminating certain types of seizures.
The procedure begins with a long skin incision that is made starting anterior to the coronal suture on the left side of the skull and extending across the midline to the right side. This incision allows for the creation of a scalp flap. Following this, burr holes are drilled slightly to the left of the midline, and the bone between these burr holes is cut using a saw or craniotome. Once the bone flap is elevated, the dura mater is opened in a curvilinear fashion, starting at the sagittal sinus and is then retracted to provide access to the underlying brain structures. A surgical microscope is utilized to facilitate dissection down the interhemispheric fissure. To ensure adequate exposure of the corpus callosum, a self-retaining retractor is employed to retract the right frontal lobe, while a second retractor is placed on the falx or contralateral cingulate gyrus. The callosal margin and the pericallosal arteries are identified as they pass over the corpus callosum. The callosal fibers are then divided using suction aspiration and bipolar coagulation, starting from the genu and anterior portion of the callosum, with careful attention to protect the pericallosal arteries. The midline raphe, which separates the lateral ventricles, is identified, and a ball dissector is used to divide the perpendicular fibers located in the posterior aspect of the corpus callosum. Upon completion of the transection, the dura is closed, and the previously elevated bone flap is replaced and secured using sutures, wires, or a miniplate and screws. Finally, the overlying muscle is repaired, and the galea and skin are closed in layers.
Post-procedure care involves monitoring the patient for any complications that may arise following the surgery. Expected recovery includes observation for neurological function and management of pain. The surgical site will require care to prevent infection, and follow-up appointments will be necessary to assess the success of the procedure in reducing seizure activity. Additional considerations may include rehabilitation services to support recovery and adaptation following the surgery.
| Short Descr | INCISION OF BRAIN TISSUE | Medium Descr | CRANIOTOMY TRANSECTION CORPUS CALLOSUM | Long Descr | Craniotomy with elevation of bone flap; for transection of corpus callosum | 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) |
| 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. | 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 | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| Pre-1990 | Added | Code added. |
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