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The CPT® Code 61791 refers to the creation of a lesion using a stereotactic method, specifically targeting the trigeminal medullary tract. This procedure involves the precise placement of a neurolytic agent, which may include substances such as alcohol, or the application of thermal, electrical, or radiofrequency energy to destroy targeted nerve tissue. The process begins with the attachment of a specialized frame to the patient's skull, which serves as a reference point for accurate positioning. Advanced imaging techniques, such as MRI or CT scans, are utilized to map the anatomical structures and identify the exact location of the lesions within the gasserian ganglion or trigeminal medullary tract. The procedure can be performed using a needle or probe apparatus that is aligned with the predetermined coordinates obtained from the imaging studies. In some cases, frameless stereotactic surgery may be employed, utilizing fiduciary markers for guidance. The needle or probe is then carefully advanced through the skin to the designated area, where the lesion is created. Depending on the method chosen, a neurolytic agent may be injected, or an electric or radiofrequency probe may be activated to ablate the targeted tissue. It is important to note that CPT® Code 61790 is designated for the creation of lesions in the gasserian ganglion, while CPT® Code 61791 is specifically for lesions in the trigeminal medullary tract.
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The procedure associated with CPT® Code 61791 is indicated for specific conditions affecting the trigeminal medullary tract. These indications may include:
The procedure for CPT® Code 61791 involves several critical steps to ensure accurate lesion creation in the trigeminal medullary tract. The steps are as follows:
After the completion of the procedure, patients may require monitoring for any immediate complications or side effects. Post-procedure care typically includes pain management and observation for any neurological deficits. Patients may experience some discomfort at the site of the procedure, and appropriate analgesics may be administered. Follow-up appointments are essential to assess the effectiveness of the procedure and to monitor for any recurrence of symptoms. Additionally, patients should be informed about potential side effects related to the neurolytic agent used or the method of ablation performed.
| Short Descr | TREAT TRIGEMINAL TRACT | Medium Descr | CREATE LES STRTCTC PRQ NEUROLYTIC TRIGEMINAL TRC | Long Descr | Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); trigeminal medullary tract | 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) | 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 | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 9 - Other OR therapeutic nervous system procedures |
| 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. | 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 | RT | Right side (used to identify procedures performed on the right side of the body) |
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| Pre-1990 | Added | Code added. |
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