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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 occur within the intracranial region, leading to significant clinical implications. The direct arterial-to-venous connection results in high-pressure blood shunting into the venous system, which can lead to serious complications, including the risk of vessel rupture and subsequent hemorrhage. The surgical procedure described by CPT® Code 61690 specifically addresses the treatment of a dural AVM, which is located within the dura mater—the tough, fibrous outer membrane that encases the central nervous system. The surgical intervention involves a craniotomy, where scalp flaps are created, burr holes are drilled, and a bone flap is elevated to access the AVM. The procedure requires meticulous dissection to expose the AVM, followed by the identification and ligation of arterial feeders and draining veins. The complete excision of the AVM is critical to prevent future complications, and post-operative angiography is performed to confirm the successful removal of the malformation. This procedure is classified as a simple dural AVM surgery, indicating that the AVM is a smaller mass of vessels without normal vessels incorporated and is not situated in a critical brain region.
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The procedure described by CPT® Code 61690 is indicated for the surgical treatment of a dural arteriovenous malformation (AVM). The following conditions may warrant this surgical intervention:
The surgical procedure for the treatment of a dural AVM involves several critical steps to ensure effective removal of the malformation:
Post-procedure care following the surgical excision of a dural AVM includes monitoring for any signs of complications, such as bleeding or infection. Patients may require imaging studies to assess the surgical site and ensure that the AVM has been completely removed. Recovery may involve a hospital stay for observation, and patients are typically advised on activity restrictions to promote healing. Follow-up appointments are essential to monitor neurological function and manage any potential post-operative symptoms.
| Short Descr | INTRACRANIAL VESSEL SURGERY | Medium Descr | INTRACRANIAL ARVEN MALFRMJ DURAL SMPL | Long Descr | Surgery of intracranial arteriovenous malformation; dural, 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) |
| 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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). | AG | Primary physician | 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. |
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