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The procedure described by CPT® Code 62164 involves a neuroendoscopic approach to excise a brain tumor. Neuroendoscopy is a minimally invasive surgical technique that utilizes a specialized endoscope to visualize and access the brain's internal structures. In this procedure, a small incision is made in the scalp to expose the skull, which is then accessed through a burr hole. This burr hole allows for the insertion of the neuroendoscope into the ventricular system of the brain. The dura mater, a protective membrane covering the brain, is incised to facilitate the introduction of the neuroendoscope. Once inside, the neuroendoscope provides a view of the brain cortex, enabling the surgeon to identify the safest path for the trocar insertion, avoiding major blood vessels. The trocar, a sharp instrument, is then introduced into the ventricle, allowing the surgeon to inspect the ventricular system and locate the tumor. During this inspection, a tissue sample may be collected for pathological examination, which is reported separately. The excision of the tumor is performed using various instruments, including forceps, curettes, and suction devices, especially if the tumor is large and requires multiple passes for complete removal. To manage any bleeding during the procedure, a cautery device is utilized through the working channel of the neuroendoscope. After the tumor is excised, if necessary, an external ventricular catheter is placed for drainage. This catheter is advanced into the ventricle through the trocar, which is subsequently removed, and the catheter is cut to the appropriate length and connected to an external drainage system. This comprehensive approach allows for effective tumor removal while minimizing damage to surrounding brain tissue.
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The procedure described by CPT® Code 62164 is indicated for the excision of brain tumors that are accessible via the ventricular system. The following conditions may warrant this procedure:
The procedure involves several critical steps to ensure the successful excision of the brain tumor:
Post-procedure care following the neuroendoscopic excision of a brain tumor includes monitoring for any complications such as bleeding or infection. Patients may require imaging studies to assess the success of the tumor removal and the placement of the ventricular catheter. Recovery may involve a hospital stay for observation, and the patient will be monitored for neurological function. Follow-up appointments will be necessary to evaluate the patient's progress and to manage any further treatment or rehabilitation needs.
| Short Descr | REMOVE BRAIN TUMOR W/SCOPE | Medium Descr | NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY | Long Descr | Neuroendoscopy, intracranial; with excision of brain tumor, including placement of external ventricular catheter for drainage | 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). | 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.) | 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 |
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| 2003-01-01 | Added | First appearance in code book in 2003. |
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