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The procedure described by CPT® Code 61567 involves a craniotomy with the elevation of a bone flap specifically for the purpose of performing multiple subpial transections (MST) accompanied by electrocorticography (ECoG) during the surgical intervention. This complex neurosurgical procedure is typically indicated for patients suffering from mesial temporal lobe epilepsy that has not responded to conventional medical therapies. The craniotomy allows for direct access to the brain, where various approaches can be utilized, including the subtemporal, transcortical, or transsylvian methods, depending on the specific anatomical considerations and the surgeon's preference. During the procedure, 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 carefully opened and separated from the underlying periosteum. The skin and muscle flap are retracted laterally to provide adequate access to the skull. A bone flap is elevated using burr holes and a craniotome, allowing the dura mater to be opened and flapped anteriorly, thereby exposing the brain cortex. The use of electrocorticography during the surgery is crucial, as it enables the surgeon to map the brain's electrical activity in real-time, helping to identify the boundaries between the epileptogenic zones and the functional areas of the cortex. This mapping is essential for the safe and effective execution of the subpial transections, which involve making small, shallow incisions in the nerve fibers located just beneath the pia mater. The procedure concludes with meticulous hemostasis, closure of the dura, and reattachment of the bone flap, followed by the reapproximation of the temporalis muscle and layered closure of the scalp. This detailed approach aims to alleviate the patient's seizure activity while preserving as much functional brain tissue as possible.
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The procedure described by CPT® Code 61567 is indicated for the treatment of mesial temporal lobe epilepsy that is unresponsive to medical therapy. This condition often necessitates surgical intervention to alleviate seizure activity and improve the patient's quality of life.
The surgical procedure begins with the patient positioned appropriately and their head secured using a three-pin fixation device to ensure stability throughout the operation. An incision is made in the temporal area, allowing access to the temporalis fascia. The fascia is opened and separated from the periosteum, and the skin and muscle flap are retracted laterally to expose the underlying skull. A bone flap is then elevated using burr holes and a craniotome, which provides access to the dura mater. The dura is opened and flapped anteriorly, exposing the brain cortex for the subsequent steps of the procedure.
Post-procedure care involves monitoring the patient for any complications related to the surgery, such as infection or bleeding. Patients may require a stay in the hospital for observation and management of pain. Recovery time can vary, and follow-up appointments are essential to assess the effectiveness of the procedure in controlling seizure activity. Rehabilitation services may also be recommended to support the patient's recovery and adaptation following surgery.
| Short Descr | INCISION OF BRAIN TISSUE | Medium Descr | CRANIOTOMY MULTIPLE SUBPIAL TRANSECTIONS W/ECOG | Long Descr | Craniotomy with elevation of bone flap; for multiple subpial transections, 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 | 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) |
| 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). | 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. | 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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| 2004-01-01 | Added | First appearance in code book in 2004. |
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