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The procedure described by CPT® Code 61864 involves the implantation of a neurostimulator electrode array in the subcortical regions of the brain, which includes areas such as the thalamus, globus pallidus, subthalamic nucleus, periventricular region, and periaqueductal gray. This intervention is primarily indicated for the treatment of various functional disorders, including those associated with Parkinson's disease, different types of tremors, multiple sclerosis, and medically intractable primary dystonias. It is also applicable for conditions resulting from psychotropic medications, as well as symptoms like bradykinesia, dyskinesia, rigidity, and severe pain due to cancer or other underlying causes. The procedure utilizes a stereotactic frame that is securely attached to the patient's skull, allowing for precise targeting of the brain regions where the electrode arrays will be implanted. Preoperative imaging techniques, such as MRI or CT scans, are employed to meticulously map the brain and determine the optimal locations and trajectories for the electrode placements. During the procedure, 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. In cases where a more extensive approach is required, a craniotomy or craniectomy may be performed, involving the development of scalp flaps and the drilling of burr holes to access the underlying bone. The dura mater is then coagulated and punctured to expose the brain surface. The entry site for the guide cannula is carefully inspected to avoid large vessels, and the brain surface is coagulated to facilitate the insertion of the guide cannula. Once in place, the deep brain stimulation array is introduced and positioned within the targeted area, followed by test stimulation to ensure optimal placement and functional results. After the procedure, the guide cannula is removed, and an anchoring device is utilized to secure the electrode array. If multiple arrays are implanted, the procedure is repeated as necessary. Finally, the galea and skin are closed, and the stereotactic frame is removed, completing the implantation process.
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The procedure described by CPT® Code 61864 is indicated for the treatment of various functional disorders, specifically:
The procedure for CPT® Code 61864 involves several critical steps to ensure the successful implantation of the neurostimulator electrode array:
After the completion of the procedure, patients are typically monitored for any immediate complications. 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 to optimize therapeutic outcomes. Recovery time can vary based on individual circumstances and the extent of the procedure performed.
| Short Descr | IMPLANT NEUROELECTRDE ADDL | Medium Descr | STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD EA 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; each additional array (List separately in addition to primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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 | 9 - Other OR therapeutic nervous system procedures |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 61863 | 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; first array |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 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). | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | LT | Left side (used to identify procedures performed on the left side of the body) | 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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| 2011-01-01 | Changed | Short description changed. |
| 2004-01-01 | Added | First appearance in code book in 2004. |
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