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An intracranial aneurysm, also referred to as a cerebral or intracerebral aneurysm, is characterized by a weakened area in the wall of a blood vessel within the brain that expands and fills with blood. This condition can lead to significant complications, including pressure on adjacent brain tissue, which may result in pain and neurological deficits. Furthermore, there is a risk of rupture, which can lead to an intracranial hemorrhage, a serious medical emergency. Intracranial aneurysms can be either congenital, meaning they are present at birth, or acquired, developing over time due to various factors. The procedure described by CPT® Code 61703 involves the surgical occlusion of an aneurysm that is supplied by the cervical carotid artery. This is achieved through the application of a Selverstone-Crutchfield type clamp via a cervical approach. The surgical intervention begins with an incision made on the side of the neck, specifically over the proximal aspect of the internal carotid artery that supplies blood to the aneurysm. The surgeon carefully dissects the artery from the surrounding tissues and applies an adjustable clamp around it to achieve partial occlusion. This partial occlusion is crucial as it promotes the thickening of the arterial walls and encourages clotting within the aneurysmal sac, thereby mitigating the risk of the aneurysm enlarging or rupturing. The unique design of the Selverstone-Crutchfield clamp allows for postoperative adjustments, as a tightening device extends to the skin surface, enabling the surgeon to modify the level of occlusion as needed. Once the desired occlusion is achieved, the surrounding tissues are meticulously closed in layers around the tightening device, ensuring proper healing and stability of the surgical site.
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The procedure described by CPT® Code 61703 is indicated for the management of intracranial aneurysms that are supplied by the cervical carotid artery. The following conditions may warrant this surgical intervention:
The surgical procedure for CPT® Code 61703 involves several critical steps to ensure the effective occlusion of the intracranial aneurysm. The following procedural steps are outlined:
After the completion of the procedure, patients will typically require monitoring for any potential complications associated with the surgery. Postoperative care may include pain management, observation for signs of neurological deficits, and ensuring the integrity of the surgical site. Patients may also need follow-up imaging studies to assess the effectiveness of the occlusion and monitor for any changes in the aneurysm. Recovery time can vary based on individual patient factors and the complexity of the procedure, but careful adherence to postoperative instructions is essential for optimal healing and outcomes.
| Short Descr | CLAMP NECK ARTERY | Medium Descr | ICRA CRV APPL OCCLUDING CLAMP CRV CRTD ART | Long Descr | Surgery of intracranial aneurysm, cervical approach by application of occluding clamp to cervical carotid artery (Selverstone-Crutchfield type) | 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) |
| 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). | 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. | 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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