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The CPT® Code 61720 refers to the creation of a lesion using a stereotactic method, which involves precise localization and recording techniques, and may be performed in single or multiple stages. This procedure specifically targets the globus pallidus or thalamus, both of which are critical subcortical structures located in the forebrain of the brain. The globus pallidus is characterized as a pale, spherical area that forms part of the lentiform nucleus, which is integral to the basal ganglia. The basal ganglia are large masses of gray matter situated at the base of the cerebral hemispheres and play a significant role in coordinating movement. The thalamus, on the other hand, is a prominent oval structure positioned just above the midbrain and serves as a relay station for sensory and motor signals to the cerebral cortex. Stereotactic lesion creation is categorized as a psychosurgical procedure and is often regarded as investigational or experimental by various payers. The procedure typically begins with the attachment of a specialized frame to the patient's skull, which ensures accurate positioning. Advanced imaging techniques such as MRI or CT scans are utilized to meticulously map the brain and identify the precise locations for lesion creation. The surgical apparatus is then calibrated to align with the MRI or CT coordinates of the targeted area. In some cases, frameless stereotactic surgery may be employed, utilizing fiduciary markers for guidance. To access the subcortical regions, one or more small incisions are made on the lateral aspect of the skull, followed by the creation of burr holes. These burr holes allow for the insertion of electrocautery probes, which are guided to the predetermined lesion site based on the stereotactic coordinates. Once positioned, a radiofrequency current is applied to ablate the targeted tissue. If the desired therapeutic outcome is not achieved during the initial surgical session, the procedure may be repeated in subsequent surgeries. For coding purposes, CPT® Code 61720 is specifically designated for the creation of lesions in the globus pallidus or thalamus, while CPT® Code 61735 is used for lesions in other subcortical structures.
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The procedure described by CPT® Code 61720 is indicated for specific neurological conditions that may benefit from the creation of lesions in the globus pallidus or thalamus. These indications may include, but are not limited to, the following:
The procedure for CPT® Code 61720 involves several critical steps to ensure accurate lesion creation in the targeted brain structures. The following outlines the procedural steps:
Following the completion of the procedure, patients are typically monitored for any immediate complications or adverse effects. Post-procedure care may include pain management, observation for neurological changes, and ensuring the integrity of the surgical site. Recovery time can vary based on individual patient factors and the extent of the procedure performed. Patients may require follow-up appointments to assess the effectiveness of the lesion and to monitor for any potential side effects or complications associated with the surgery. It is essential for healthcare providers to provide thorough post-operative instructions and support to facilitate optimal recovery.
| Short Descr | INCISE SKULL/BRAIN SURGERY | Medium Descr | CRTJ LES STRTCTC BURR GLOBUS PALLIDUS/THALAMUS | Long Descr | Creation of lesion by stereotactic method, including burr hole(s) and localizing and recording techniques, single or multiple stages; globus pallidus or thalamus | 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) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 1 - Incision and excision of CNS |
| 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. | 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.) | 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. |
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