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The procedure described by CPT® Code 61698 involves the surgical intervention for a complex intracranial aneurysm located within the vertebrobasilar 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. These factors contribute to the complexity of the surgical procedure. In cases where the surgical approach necessitates temporary occlusion of blood vessels, trapping of the aneurysm, or the use of cardiopulmonary bypass, the aneurysm is classified as complex, indicating a higher level of surgical difficulty and risk. The surgical approach is tailored to 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 isolates the artery from the surrounding arachnoid membrane, allowing for direct exposure of the aneurysm. Treatment options for the aneurysm include clipping and resecting the mass lesion, followed by vessel reconstruction through direct repair or bypass grafting. Alternatively, if there is sufficient collateral circulation, the aneurysm may be trapped, with clips applied above and below the lesion to achieve complete occlusion.
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The procedure is indicated for the treatment of complex intracranial aneurysms located in the vertebrobasilar circulation. These aneurysms are characterized by specific features that necessitate surgical intervention, including:
The surgical procedure for addressing a complex intracranial aneurysm in the vertebrobasilar circulation involves several critical steps:
Post-procedure care for patients undergoing surgery for a complex intracranial aneurysm includes monitoring for potential complications such as bleeding, infection, or neurological deficits. Patients may require intensive care unit (ICU) admission for close observation following the surgery. Recovery may involve a hospital stay for several days, during which the patient's neurological status and vital signs are closely monitored. Rehabilitation may be necessary depending on the extent of the surgery and the patient's preoperative condition. Follow-up imaging studies may be performed to assess the success of the procedure and ensure that the aneurysm has been adequately treated.
| Short Descr | BRAIN ANEURYSM REPR COMPLX | Medium Descr | CPLX INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ | Long Descr | Surgery of complex intracranial aneurysm, intracranial approach; vertebrobasilar 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 | 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). | 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. | 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. | 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). | 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 |
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| 2011-01-01 | Changed | Short description changed. |
| 2001-01-01 | Added | First appearance in code book in 2001. |
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