© Copyright 2025 American Medical Association. All rights reserved.
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 occur in the intracranial region, leading to significant clinical implications. In the case of intracranial AVMs, the direct arterial-to-venous connection results in high-pressure blood shunting into the venous system, which can lead to serious complications such as vessel rupture and hemorrhage. AVMs can be classified based on their anatomical location; those located above the tentorium cerebelli are referred to as supratentorial AVMs, while those situated below are termed infratentorial AVMs. The infratentorial region encompasses critical structures such as the cerebellum, cerebellopontine angle, fourth ventricle, and brain stem. The surgical procedure for addressing a complex infratentorial AVM involves a craniotomy, which includes creating scalp flaps, drilling burr holes, and elevating 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 leading to the complete excision of the AVM. This surgical intervention is crucial for preventing potential life-threatening complications associated with AVMs.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure for the surgery of an intracranial arteriovenous malformation (AVM) is indicated in the following scenarios:
The surgical procedure for the excision of a complex infratentorial AVM involves several critical steps:
Post-procedure care following the excision of a complex infratentorial AVM includes monitoring for any signs of complications such as hemorrhage, infection, or neurological deficits. Patients may require intensive care unit (ICU) admission for close observation, especially in the immediate postoperative period. Pain management, neurological assessments, and imaging studies may be necessary to ensure proper recovery. Rehabilitation services may also be initiated to address any deficits resulting from the AVM or the surgical intervention. Follow-up appointments are essential to monitor the patient's recovery and to assess for any recurrence of symptoms or complications.
| Short Descr | INTRACRANIAL VESSEL SURGERY | Medium Descr | INTRACRANIAL ARVEN MALFRMJ INFRATENTRL CMPL | Long Descr | Surgery of intracranial arteriovenous malformation; infratentorial, 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. | 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. | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) |
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| Pre-1990 | Added | Code added. |