CPT® Code 61892

1. Indications

The procedure associated with CPT® Code 61892 is indicated for the following conditions:

• Device Malfunction The removal of the cranial neurostimulator may be necessary if the device is not functioning as intended, which can lead to inadequate treatment of the underlying condition.
• Complications Any complications arising from the implanted device, such as infection or adverse reactions, may necessitate its removal to ensure patient safety and health.
• Patient Intolerance If the patient experiences intolerable side effects or discomfort from the neurostimulator therapy, removal of the device may be warranted to alleviate these issues.

2. Procedure

The procedure for the removal of the skull-mounted cranial neurostimulator pulse generator or receiver involves several critical steps:

• Step 1: Anesthesia Administration The procedure begins with the administration of general anesthesia to ensure that the patient is completely unconscious and free from pain during the surgery.
• Step 2: Scalp Flap Reopening The surgeon carefully reopens the scalp flap that was previously created to access the neurostimulator. This involves making an incision in the scalp to expose the underlying tissues.
• Step 3: Tissue Manipulation Once the scalp flap is opened, the surgeon gently draws aside the muscle and underlying tissues to gain access to the cranial neurostimulator device. This step requires precision to avoid damage to surrounding structures.
• Step 4: Device Removal The cranial neurostimulator pulse generator or receiver is then accessed and removed from its position within the skull. This step is critical, as it involves careful handling to prevent complications.
• Step 5: Cranioplasty (if required) If cranioplasty is necessary due to the removal of the device, the surgeon will fit a bone graft or synthetic material, such as calcium phosphate or hydroxyapatite, into the area where the device was located. This material is anchored in place using titanium plates or mesh to restore the integrity of the skull.
• Step 6: Alternative Implantation (if applicable) In some cases, a customized implant made from polymethyl methacrylate or polyetheretherketone may be used to fill the void left by the device, providing a tailored solution for skull reconstruction.
• Step 7: Closure After the skull has been repaired, the muscle tissue is repositioned over the skull, and the scalp flap is sutured back into place, completing the procedure.

3. Post-Procedure

Post-procedure care following the removal of the cranial neurostimulator includes monitoring the patient for any signs of complications, such as infection or excessive bleeding. Patients may experience discomfort at the surgical site, which can be managed with appropriate pain relief medications. Follow-up appointments are essential to assess the healing process and ensure that the cranioplasty, if performed, is successful. Patients should be advised on activity restrictions and signs of complications to report to their healthcare provider. Proper wound care instructions will also be provided to promote healing and prevent infection.