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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 can be classified based on their location within the brain, with infratentorial AVMs situated below the tentorium cerebelli, which separates the cerebellum and brainstem from the cerebrum. The infratentorial region includes critical structures such as the cerebellum, cerebellopontine angle, fourth ventricle, and brainstem. The surgical procedure coded as CPT® 61684 specifically addresses the surgical intervention for a simple infratentorial AVM. This procedure involves a craniotomy, where the scalp is incised to create flaps, burr holes are drilled into the skull, and a bone flap is elevated to access the dura mater. The AVM is then meticulously exposed, and using microsurgical techniques, the arterial feeders and draining veins are identified, ligated, and excised. The goal of the surgery is to completely remove the AVM to prevent potential complications such as hemorrhage, which can arise from the high-pressure blood flow associated with these malformations.
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The procedure coded as CPT® 61684 is indicated for the surgical treatment of a simple infratentorial arteriovenous malformation (AVM). The following conditions may warrant this surgical intervention:
The surgical procedure for CPT® 61684 involves several critical steps to ensure the safe and effective removal of the AVM:
Post-procedure care following the surgical intervention for a simple infratentorial AVM includes monitoring for any signs of complications such as bleeding or infection. Patients may require a stay in the intensive care unit (ICU) for close observation, especially in the immediate postoperative period. Neurological assessments will be conducted regularly to evaluate the patient's recovery and detect any potential deficits. Pain management and rehabilitation may also be part of the recovery process, depending on the extent of the surgery and the patient's overall condition. Follow-up imaging studies may be necessary to ensure that the AVM has not recurred and that the brain is healing appropriately.
| Short Descr | INTRACRANIAL VESSEL SURGERY | Medium Descr | INTRACRANIAL ARVEN MALFRMJ INFRATENTRL SMPL | Long Descr | Surgery of intracranial arteriovenous malformation; infratentorial, simple | 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. | 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). | 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). | 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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| Pre-1990 | Added | Code added. |