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The procedure described by CPT® Code 61868 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, different types of tremors, multiple sclerosis, medically intractable primary dystonias, and symptoms related to psychotropic medications. Additionally, it addresses issues like bradykinesia, dyskinesia, rigidity, and severe pain associated with cancer or other underlying causes. The process begins with the attachment of a stereotactic frame to the patient's skull, which is essential for precise navigation during the surgery. Advanced imaging techniques, such as MRI or CT scans, are utilized to meticulously map the brain, allowing the surgical team to determine the optimal locations for electrode array placement. The procedure may involve creating twist drill holes or burr holes to access the targeted implantation sites, with careful localization and marking of entry points on the skin. In some cases, a craniotomy or craniectomy may be performed to provide direct access to the brain. Throughout the procedure, the surgical team employs intraoperative microelectrode recording to ensure accurate placement and functionality of the neurostimulator arrays, ultimately aiming to achieve the best possible therapeutic outcomes for the patient.
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The procedure described by CPT® Code 61868 is indicated for the treatment of various functional disorders, particularly those associated with neurological conditions. The specific indications include:
The procedure for CPT® Code 61868 involves several critical steps to ensure the successful implantation of the neurostimulator electrode array. The process begins with the attachment of a stereotactic frame to the patient's skull, which is essential for accurate targeting during the surgery. Following this, MRI or CT scans are utilized to create a detailed map of the brain, allowing the surgical team to determine the number and precise locations for the electrode arrays. Once the trajectories for array placements are established, the surgical team marks the entry points on the skin and incises the skin to access the implantation sites.
After the completion of the procedure, patients are typically monitored for any immediate complications or adverse effects. Post-operative care may include pain management, monitoring for signs of infection, and ensuring the proper healing of the surgical site. Patients may also undergo follow-up evaluations to assess the effectiveness of the neurostimulator arrays and make any necessary adjustments to optimize therapeutic outcomes. Rehabilitation and physical therapy may be recommended to help patients regain strength and mobility as they recover from the surgery.
| Short Descr | IMPLANT NEUROELECTRDE ADDL | Medium Descr | STRTCTC IMPLTJ NSTIM ELTRD W/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), with 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 | 2 | 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.
| 61867 | MPFS Status: Active Code APC C Physician Quality Reporting 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), with 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 | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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. | 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). | RT | Right side (used to identify procedures performed on the right side of the body) | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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). | 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. | 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). | CR | Catastrophe/disaster related | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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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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