CPT® Code 61544

Official Description

Craniotomy with elevation of bone flap; for excision or coagulation of choroid plexus

Common Language Description

The procedure described by CPT® Code 61544 involves a craniotomy with elevation of a bone flap specifically for the excision or coagulation of the choroid plexus. The choroid plexus is a network of blood vessels located within the four ventricles of the brain, playing a crucial role in the production of cerebrospinal fluid (CSF). This fluid is essential for cushioning the brain, maintaining intracranial pressure, and facilitating the exchange of nutrients and waste. The choroid plexus is composed of capillaries that are separated from the ventricular spaces by specialized choroid epithelial cells, which filter blood to produce CSF. The excision or coagulation of the choroid plexus is typically indicated for certain types of hydrocephalus, a condition characterized by an accumulation of CSF within the ventricles, leading to increased intracranial pressure. The surgical procedure begins with an incision in the skin and the creation of scalp flaps, followed by the drilling of burr holes in the skull. A craniotome or saw is then used to cut the bone between these burr holes, allowing for the elevation of a bone flap. After the bone flap is lifted, the dura mater, which is the outermost layer of the protective covering of the brain, is opened and retracted to access the underlying brain tissue. During the procedure, careful dissection of the brain tissue is performed to avoid damaging critical structures. The surgeon then enters the ventricular system to excise a portion of the choroid plexus or to destroy it through coagulation techniques, such as electrocautery or laser. Following the excision or coagulation, the dura is closed, the bone flap is replaced and secured using sutures, wires, or miniplates and screws, and the overlying muscle and skin are repaired in layers. This meticulous approach ensures that the integrity of the brain and surrounding structures is maintained while addressing the underlying condition effectively.

1. Indications

The procedure described by CPT® Code 61544 is indicated for the treatment of specific conditions related to the choroid plexus, particularly:

Hydrocephalus - A condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain, which can lead to increased intracranial pressure and associated neurological symptoms.

2. Procedure

The procedure for CPT® Code 61544 involves several critical steps to ensure effective access and treatment of the choroid plexus:

Step 1: Incision and Scalp Flap Creation - The procedure begins with a surgical incision in the scalp, followed by the creation of scalp flaps to provide access to the underlying skull. This step is essential for exposing the area where the craniotomy will be performed.
Step 2: Burr Hole Drilling - After the scalp flaps are created, burr holes are drilled into the skull. These holes serve as access points for the subsequent steps of the procedure.
Step 3: Bone Flap Elevation - The bone between the burr holes is then cut using a craniotome or saw. This allows for the elevation of a bone flap, which is necessary to access the brain tissue beneath.
Step 4: Dura Opening and Retraction - Once the bone flap is elevated, the dura mater, the protective outer layer of the brain, is opened and retracted. This step is crucial for gaining access to the brain and the ventricular system.
Step 5: Brain Tissue Dissection - The surgeon carefully dissects the brain tissue, taking care to preserve critical structures. This meticulous dissection is vital to avoid damaging important areas of the brain during the procedure.
Step 6: Accessing the Ventricular System - The ventricular system is entered, allowing the surgeon to visualize and access the choroid plexus directly.
Step 7: Excision or Coagulation of Choroid Plexus - A portion of the choroid plexus is excised or destroyed through coagulation techniques, such as electrocautery or laser. This step is performed to alleviate the symptoms of hydrocephalus by reducing the production of CSF.
Step 8: Closure of Dura and Bone Flap Replacement - After the desired portion of the choroid plexus has been treated, the dura is closed. The bone flap is then replaced and secured using sutures, wires, or miniplates and screws to restore the integrity of the skull.
Step 9: Muscle and Skin Repair - Finally, the overlying muscle is repaired, and the galea and skin are closed in layers to complete the procedure and promote proper healing.

3. Post-Procedure

Post-procedure care following a craniotomy for excision or coagulation of the choroid plexus typically involves monitoring the patient for any signs of complications, such as infection or bleeding. Patients may require pain management and close observation in a recovery area. The expected recovery period can vary based on individual patient factors and the extent of the procedure performed. Follow-up appointments are essential to assess the patient's neurological status and to ensure that the treatment has effectively addressed the underlying condition of hydrocephalus. Rehabilitation services may also be recommended to support recovery and optimize functional outcomes.

Short Descr	REMOVE & TREAT BRAIN LESION
Medium Descr	CRANIOTOMY EXCISION/COAGULATION CHOROID PLEXUS
Long Descr	Craniotomy with elevation of bone flap; for excision or coagulation of choroid plexus
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)	0 - Co-surgeons not permitted for this procedure.
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)