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Official Description

Neuroendoscopy, intracranial; with dissection of adhesions, fenestration of septum pellucidum or intraventricular cysts (including placement, replacement, or removal of ventricular catheter)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 62161 involves a neuroendoscopic approach to address issues within the intracranial space, specifically targeting adhesions, the septum pellucidum, or intraventricular cysts. This minimally invasive technique begins with a small incision in the scalp, followed by the creation of a burr hole in the skull to provide access to the brain's ventricular system. The neuroendoscope, a specialized instrument equipped with a camera and light source, is inserted through this burr hole, allowing for direct visualization of the affected area. The procedure is designed to dissect any adhesions that may be obstructing the flow of cerebrospinal fluid (CSF) and to fenestrate cysts or the septum pellucidum to enhance CSF circulation. The septum pellucidum is a thin membrane that separates the lateral ventricles of the brain, and its manipulation can facilitate better communication of CSF throughout the ventricular system. If necessary, a ventricular catheter may be placed to manage CSF drainage, ensuring that the patient’s intracranial pressure is appropriately regulated. This procedure is critical for alleviating symptoms associated with CSF obstruction and improving overall neurological function.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The neuroendoscopic procedure described by CPT® Code 62161 is indicated for the following conditions:

  • Adhesions - Presence of adhesions that obstruct the flow of cerebrospinal fluid (CSF), potentially leading to increased intracranial pressure or other neurological symptoms.
  • Intraventricular Cysts - The presence of cysts within the ventricles that may require fenestration to alleviate symptoms or prevent complications associated with CSF flow obstruction.
  • Septum Pellucidum Issues - Conditions necessitating the manipulation or fenestration of the septum pellucidum to improve CSF circulation and reduce the risk of hydrocephalus.

2. Procedure

The neuroendoscopic procedure involves several critical steps to ensure effective treatment:

  • Step 1: Incision and Burr Hole Creation - A small incision is made in the scalp, and a burr hole is created in the skull to provide access to the intracranial space. This step is crucial for visualizing the area where the adhesions, cyst, or septum pellucidum is located.
  • Step 2: Dura Incision and Neuroendoscope Insertion - The dura mater, a protective membrane covering the brain, is incised, allowing for the insertion of the neuroendoscope through the burr hole. This instrument enables direct visualization of the brain's internal structures.
  • Step 3: Trocar Introduction - A trocar is introduced into the ventricle to facilitate access for the neuroendoscope. The inner stylet of the trocar is removed, and the neuroendoscope is advanced to the site of the adhesions, cyst, or septum pellucidum.
  • Step 4: Dissection of Adhesions or Cyst Fenestration - If adhesions are present, they are carefully dissected to restore normal CSF flow. In cases of intraventricular cysts, the cyst wall is opened, and a second opening is created to allow for drainage and inspection of the cyst's interior.
  • Step 5: Septum Pellucidum Manipulation - The septum pellucidum may be opened to enhance CSF circulation. This structure is typically fused in the middle, and its manipulation can improve communication between the lateral ventricles.
  • Step 6: Ventricular Catheter Placement - If indicated, a ventricular catheter is advanced into the ventricle through the trocar. The catheter is positioned appropriately, and the trocar is removed. The catheter is then cut to the desired length and connected to a one-way, flow-controlled valve.
  • Step 7: Closure of Incisions - Finally, all incisions are closed to complete the procedure, ensuring that the patient is prepared for recovery.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any signs of complications, such as infection or bleeding. The patient may require imaging studies to assess the effectiveness of the procedure and the proper functioning of the ventricular catheter if placed. Recovery time can vary based on the individual patient's condition and the extent of the procedure performed. Follow-up appointments are essential to evaluate the patient's neurological status and ensure that cerebrospinal fluid circulation is adequate.

Short Descr DISSECT BRAIN W/SCOPE
Medium Descr NUNDSC ICRA DSJ ADS FENESTRATION SEPTUM CSTS
Long Descr Neuroendoscopy, intracranial; with dissection of adhesions, fenestration of septum pellucidum or intraventricular cysts (including placement, replacement, or removal of ventricular catheter)
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) 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 1 - Incision and excision of CNS
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).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
GC This service has been performed in part by a resident under the direction of a teaching physician
Date
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Notes
2003-01-01 Added First appearance in code book in 2003.
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