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An arteriovenous malformation (AVM) is a pathological condition characterized by an abnormal connection between the arterial and venous systems, where one or more arteries and veins connect directly without the intermediary of capillaries. This congenital malformation can lead to significant complications due to the high-pressure blood flow directly from arteries into veins, bypassing the normal capillary network. Intracranial AVMs, specifically, are located within the skull and can be classified based on their anatomical location. A supratentorial AVM is situated above the tentorium cerebelli, which is a membrane that separates the cerebrum from the cerebellum and houses critical structures such as the cerebral hemispheres, lateral and third ventricles, choroid plexus, hypothalamus, and the pituitary and pineal glands. In contrast, an infratentorial AVM is found below the tentorium cerebelli, encompassing the cerebellum, brain stem, and fourth ventricle. The surgical procedure for addressing a complex supratentorial AVM involves a craniotomy, which entails creating scalp flaps and burr holes, followed by the removal of a bone flap to access the dura mater and expose the AVM. The procedure requires meticulous microsurgical techniques to identify and ligate the arterial feeders and draining veins, ultimately excising the AVM completely. This complex surgical intervention is critical to prevent potential life-threatening complications such as hemorrhage, which can arise from the high-pressure shunting of blood through the abnormal vessels.
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The procedure for the surgical intervention of a complex supratentorial arteriovenous malformation (AVM) is indicated in the following scenarios:
The surgical procedure for a complex supratentorial AVM involves several critical steps:
Post-procedure care for patients who have undergone surgery for a complex supratentorial AVM includes monitoring for any signs of complications such as bleeding, infection, or neurological deficits. Patients may require imaging studies to assess the surgical site and ensure that the AVM has been completely excised. Recovery may involve a stay in the intensive care unit (ICU) for close observation, followed by rehabilitation to address any neurological deficits that may have occurred prior to or during the procedure. The overall recovery process can vary based on the individual patient's condition and the extent of the surgical intervention.
| Short Descr | INTRACRANIAL VESSEL SURGERY | Medium Descr | INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL CMPL | Long Descr | Surgery of intracranial arteriovenous malformation; supratentorial, complex | 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 | 59 - Other OR procedures on vessels of head and neck |
This is a primary code that can be used with these additional add-on codes.
| 61316 | Addon Code MPFS Status: Active Code APC C Incision and subcutaneous placement of cranial bone graft (List separately in addition to code for primary procedure) | 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) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 | RT | Right side (used to identify procedures performed on the right side of the body) |
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| Pre-1990 | Added | Code added. |
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