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The procedure described by CPT® Code 61566 involves a craniotomy, which is a surgical operation where a portion of the skull is removed to access the brain. Specifically, this procedure includes the elevation of a bone flap for a selective amygdalohippocampectomy (SAH), a surgical technique aimed at treating mesial temporal lobe epilepsy that has not responded to conventional medical therapies. The amygdalohippocampectomy targets specific areas of the brain, namely the amygdala and hippocampus, which are critical in the generation of seizures associated with this type of epilepsy. The procedure can be performed using various approaches, including the subtemporal approach, which is conducted beneath the temporal lobe; the transcortical approach, which involves passing through the cortex and gray matter; or the transsylvian approach, which entails a wide dissection of the sylvian fissure. During the operation, the patient's head is secured using a three-pin fixation device to ensure stability. An incision is made in the temporal area to expose the temporalis fascia, which is then opened and separated from the periosteum. The skin and muscle flap are retracted laterally to allow access to the skull, where a bone flap is elevated using burr holes and a craniotome. The dura mater, a protective membrane covering the brain, is opened and flapped anteriorly to provide access to the brain cortex for the selective amygdalohippocampectomy. This procedure is critical for patients suffering from intractable epilepsy, as it aims to remove the epileptogenic tissue while preserving surrounding functional brain areas. The detailed steps involved in the procedure ensure that the surgical team can effectively address the underlying causes of the patient's seizures while minimizing potential complications.
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The procedure described by CPT® Code 61566 is indicated for the treatment of mesial temporal lobe epilepsy that is unresponsive to medical therapy. This condition is characterized by recurrent seizures originating from the temporal lobe, often associated with significant morbidity and impaired quality of life. The selective amygdalohippocampectomy aims to alleviate seizure activity by removing the affected brain tissue, specifically targeting the amygdala and hippocampus, which are known to play a crucial role in seizure generation.
The procedure begins with the patient positioned appropriately and their head secured using a three-pin fixation device to ensure stability throughout the surgery. An incision is made in the temporal area to expose the temporalis fascia, which is then opened and separated from the periosteum. The skin and muscle flap are retracted laterally to provide access to the skull. A bone flap is elevated using burr holes and a craniotome, allowing the surgical team to access the underlying dura mater. The dura is then opened and flapped anteriorly to expose the brain cortex, which is essential for performing the selective amygdalohippocampectomy.
At the conclusion of the selective amygdalohippocampectomy, bleeding is controlled using electrocautery and/or gelfoam to minimize the risk of postoperative complications. The dura is then closed, and the elevated bone flap is plated back into position. The temporalis muscle is reapproximated, and the scalp is closed in layers to ensure proper healing. Post-procedure care includes monitoring for any signs of complications, managing pain, and providing appropriate follow-up to assess the patient's recovery and seizure control.
| Short Descr | REMOVAL OF BRAIN TISSUE | Medium Descr | CRANIOTOMY SELECTIVE AMYGDALOHIPPOCAMPECTOMY | Long Descr | Craniotomy with elevation of bone flap; for selective amygdalohippocampectomy | 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 | 9 - Other OR therapeutic nervous system procedures |
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 |
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| 2004-01-01 | Added | First appearance in code book in 2004. |