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Official Description

Surgery of complex intracranial aneurysm, intracranial approach; carotid circulation

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 61697 involves the surgical intervention for a complex intracranial aneurysm located within the carotid circulation, utilizing an intracranial approach. A complex intracranial aneurysm is characterized by specific features that complicate its treatment, including a size greater than 15 mm, the presence of calcification at the neck of the aneurysm, and the involvement of normal blood vessels within the aneurysm neck. Additionally, if the surgical procedure necessitates temporary occlusion of the blood vessel, trapping of the aneurysm, or the use of cardiopulmonary bypass to achieve successful treatment, the aneurysm is classified as complex. The surgical approach is determined by the precise location of the aneurysm, which may involve accessing the aneurysm through the interhemispheric fissure or the pterion. The procedure begins with an incision through the skin and subcutaneous tissue, followed by the removal of the overlying bone through a craniectomy. Once the dura mater is opened, the arachnoid membrane is carefully nicked, and cerebrospinal fluid may be drained to enhance visibility and access to the internal carotid or vertebrobasilar artery. The surgeon then identifies and separates the artery from the arachnoid membrane to expose the aneurysm. Treatment options for the aneurysm include clipping and resecting the mass lesion, followed by vessel reconstruction through direct repair with a bypass graft. Alternatively, if there is sufficient collateral circulation, the aneurysm may be trapped, with clips applied above and below the lesion to achieve complete occlusion.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure is indicated for the treatment of complex intracranial aneurysms located in the carotid circulation. These aneurysms are typically characterized by specific features that necessitate surgical intervention, including:

  • Size Greater than 15 mm: Aneurysms that exceed this size are considered complex due to the increased risk of rupture and complications.
  • Calcification of the Aneurysm Neck: The presence of calcification can complicate the surgical approach and treatment of the aneurysm.
  • Incorporation of Normal Vessels: Aneurysms that involve normal blood vessels within their neck pose additional challenges during surgical intervention.
  • Need for Temporary Vessel Occlusion: If the surgical procedure requires temporary occlusion of the affected vessel, it classifies the aneurysm as complex.
  • Trapping or Cardiopulmonary Bypass: The necessity of these techniques for successful treatment further categorizes the aneurysm as complex.

2. Procedure

The surgical procedure for addressing a complex intracranial aneurysm involves several critical steps, which are detailed as follows:

  • Step 1: Incision and Craniectomy The procedure begins with a surgical incision through the skin and subcutaneous tissue to access the cranial cavity. Following this, a craniectomy is performed, which involves the removal of the overlying bone to create an opening in the skull, allowing access to the brain and the aneurysm.
  • Step 2: Opening the Dura Mater After the craniectomy, the dura mater, which is the protective covering of the brain, is carefully opened to expose the underlying structures. This step is crucial for gaining access to the aneurysm.
  • Step 3: Nicking the Arachnoid and Draining Cerebrospinal Fluid The next step involves nicking the arachnoid membrane, which is another layer of protection around the brain. At this point, cerebrospinal fluid may be drained as necessary to facilitate maximal exposure of the internal carotid or vertebrobasilar artery, which is essential for the subsequent steps of the procedure.
  • Step 4: Identifying and Separating the Artery The surgeon then locates the artery and carefully separates it from the arachnoid membrane. This step is critical for exposing the aneurysm and ensuring that the surgical field is clear for treatment.
  • Step 5: Exposing the Aneurysm Once the artery is separated, the aneurysm is exposed, allowing the surgeon to assess its condition and determine the appropriate treatment method.
  • Step 6: Treatment of the Aneurysm The aneurysm may be treated through clipping and resecting the mass lesion, which involves placing a clip across the neck of the aneurysm to prevent blood flow into it. Alternatively, if collateral circulation is deemed adequate, the aneurysm may be trapped, with clips applied above and below the lesion to achieve complete occlusion.
  • Step 7: Vessel Reconstruction Following the treatment of the aneurysm, vessel reconstruction is performed. This may involve direct repair of the artery or the use of a bypass graft to restore normal blood flow.

3. Post-Procedure

Post-procedure care for patients undergoing surgery for a complex intracranial aneurysm typically involves close monitoring in a hospital setting. Patients may require observation for neurological status, management of pain, and monitoring for potential complications such as bleeding or infection. Recovery may vary based on the complexity of the procedure and the patient's overall health. Rehabilitation services may be necessary to assist with recovery, particularly if there are any neurological deficits following the surgery. Follow-up appointments will be essential to assess the success of the procedure and to monitor for any recurrence of the aneurysm.

Short Descr BRAIN ANEURYSM REPR COMPLX
Medium Descr COMPLX INTRACRANIAL ARYSM CAROTID CIRCULATION
Long Descr Surgery of complex intracranial aneurysm, intracranial approach; carotid circulation
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 2
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)
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).
GC This service has been performed in part by a resident under the direction of a teaching physician
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).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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).
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.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
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.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure 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
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
LT Left side (used to identify procedures performed on the left side of the body)
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
RT Right side (used to identify procedures performed on the right side of the body)
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2011-01-01 Changed Short description changed.
2001-01-01 Added First appearance in code book in 2001.
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