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The procedure described by CPT® Code 61863 involves the implantation of a neurostimulator electrode array in the subcortical regions of the brain, which are critical areas for managing various functional disorders. This procedure is particularly relevant for patients suffering from conditions such as Parkinson's disease, tremors, multiple sclerosis, and medically intractable primary dystonias. It also addresses symptoms related to psychotropic medications, including bradykinesia, dyskinesia, rigidity, and severe pain associated with cancer or other causes. The implantation is performed using a stereotactic approach, which allows for precise targeting of the brain's subcortical structures, such as the thalamus, globus pallidus, subthalamic nucleus, periventricular area, and periaqueductal gray. To initiate the procedure, a stereotactic frame is securely attached to the patient's skull, ensuring stability and accuracy during the operation. Imaging techniques, such as MRI or CT scans, are employed to meticulously map the brain and identify the optimal locations for electrode array placement. The number of arrays to be implanted and their specific trajectories are determined based on this imaging data. Access to the implantation sites is achieved through twist drill holes or burr holes, which are localized and marked on the skin before incising it. The procedure may also involve a craniotomy or craniectomy, where scalp flaps are developed, burr holes are drilled, and the bone is cut to create a bone flap or remove a portion of the skull. Once the dura mater is opened, the brain surface is exposed, allowing for the careful insertion of a guide cannula into the targeted area. The deep brain stimulation array is then positioned, and test stimulation is conducted to ensure optimal placement and functionality. After confirming the desired results, the guide cannula is removed, and the electrode array is anchored in place. The procedure concludes with the closure of the galea and skin, followed by the removal of the stereotactic frame. This comprehensive approach ensures that the neurostimulator array is accurately placed to provide therapeutic benefits for the patient.
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The procedure described by CPT® Code 61863 is indicated for the treatment of various functional disorders, particularly those that are resistant to conventional therapies. The specific indications include:
The procedure for CPT® Code 61863 involves several critical steps to ensure the successful implantation of the neurostimulator electrode array. The following procedural steps are outlined:
After the completion of the procedure, patients are typically monitored for any immediate complications or adverse effects. Post-procedure care may include pain management, monitoring for signs of infection, and ensuring proper healing of the incision sites. Patients may also require follow-up appointments to assess the functionality of the implanted neurostimulator and make any necessary adjustments. Recovery time can vary based on individual circumstances, but patients are generally advised to avoid strenuous activities during the initial healing period. It is essential for healthcare providers to provide clear instructions regarding post-operative care and any restrictions to ensure optimal recovery and outcomes.
| Short Descr | IMPLANT NEUROELECTRODE | Medium Descr | STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD 1ST ARRAY | Long Descr | Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array | 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) | 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 | 9 - Other OR therapeutic nervous system procedures |
This is a primary code that can be used with these additional add-on codes.
| 61864 | Addon Code MPFS Status: Active Code APC C Illustration for Code Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; each additional array (List separately in addition to primary procedure) |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 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). | LT | Left side (used to identify procedures performed on the left side of the body) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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). | 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). | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2004-01-01 | Added | First appearance in code book in 2004. |
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