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Laser interstitial thermal therapy (LITT) is a sophisticated and minimally invasive surgical technique utilized for the treatment of intracranial lesions. This procedure employs a laser that is delivered through a thin fiber optic cable, which is precisely guided to the target area within the brain using real-time magnetic resonance imaging (MRI) mapping. The process begins with the creation of a small burr hole in the skull, allowing access to the brain tissue. Once the laser is positioned at the lesion site, it generates heat that effectively destroys the targeted tissue. LITT is particularly beneficial for addressing recurrent brain tumors that are located deep within the brain and may not be amenable to traditional surgical approaches. Additionally, this technique can be employed to manage complications such as radiation necrosis, which can arise following radiation therapy for brain tumors, as well as to treat epilepsy when the precise origin of the seizures can be identified. The procedure is typically performed under general anesthesia, ensuring patient comfort and safety. Prior to the intervention, stereotactic imaging, either through MRI or CT scans, is conducted to accurately locate the lesions and plan the optimal trajectory for laser insertion. In cases where multiple or complex lesions are present, multiple trajectories may be necessary to achieve effective treatment. The procedure involves making a stab incision and drilling a burr hole, through which the fiberoptic laser is carefully navigated. Continuous MRI monitoring is employed to confirm the laser's position and to regulate the temperature of the surrounding tissues, ensuring that only the intended lesion is ablated. Upon completion of the procedure, the laser is withdrawn, and the incision site is irrigated and closed. It is important to note that CPT® Code 61736 is designated for single trajectory ablation of a simple lesion, while CPT® Code 61737 encompasses the use of multiple trajectories for treating multiple lesions or a single complex lesion.
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The indications for performing laser interstitial thermal therapy (LITT) include the following:
The procedural steps for laser interstitial thermal therapy (LITT) are as follows:
Post-procedure care for patients undergoing laser interstitial thermal therapy (LITT) typically involves monitoring in a recovery area to assess for any immediate complications. Patients may experience some swelling or discomfort at the incision site, which can be managed with appropriate pain relief. Follow-up imaging may be scheduled to evaluate the effectiveness of the treatment and to monitor for any potential recurrence of the lesion. The expected recovery time can vary depending on the individual patient and the complexity of the procedure, but LITT generally allows for a quicker recovery compared to traditional open surgery. Patients are advised to follow their physician's instructions regarding activity restrictions and any necessary follow-up appointments to ensure optimal recovery and outcomes.
| Short Descr | LITT ICR MLT TRJ MLT/CPLX LS | Medium Descr | LITT LES ICR MLT TRAJECTORIES MLT/CPLX LESIONS | Long Descr | Laser interstitial thermal therapy (LITT) of lesion, intracranial, including burr hole(s), with magnetic resonance imaging guidance, when performed; multiple trajectories for multiple or complex lesion(s) | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - 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 | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| 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. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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). | 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. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 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). | 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 | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2022-01-01 | Added | Code added |
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