Nervous System

NERVOUS SYSTEM
61000-64999
Skull, Meninges, and Brain (61000-62258)
Procedural Terms – Definitions:
 Burr hole: An air powered drill is used to make a hole in the skull. The dura mater
(tough covering of the brain) is then opened.
 Trephining: The removal of a circular disk of the cranium. It is performed with a
trephine, a small circular saw with a center pin mounted on a hollow metal shaft to
which is attached a transverse handle.
 Twist drill: Craniotomy with a mechanical twist drill is a standard, minimally
invasive procedure in neurosurgery, widely used for the drainage of chronic
subdural hematomas and the placement of ventricular drains.
Skull, Meninges, and Brain (61000- 62258)
Procedural Terms – Definitions:
 Craniectomy: Surgical removal of a portion of the cranium; elevated flap to do

surgery is not replaced
 Craniotomy: Any operation on the cranium or incision into the cranium;

elevated flap is replaced
 Tentorium: A fold of the dura mater which separates the cerebellum from the
cerebrum and often encloses a process or plate of the skull called the bony
tentorium.
Skull, Meninges, and Brain (61000- 62258)
EXAMPLES:
1. A physician uses a surgical drill to create a trephine hole in the skull and then
biopsies a brain tumor through the hole. How should these services be reported?
Answer: 61140
2. A physician injects a steroid into the spinal canal in the cervical area. How should
these services be reported?
Answer: 62320
Points to remember
 A burr hole is often necessary in anticipation for intracranial surgery (e.g.

craniotomy, craniectomy) I either to gain access to intracranial contents, to
alleviate pressure in anticipation of further surgery or to place an intracranial
pressure monitoring device as part of the surgery.
 In addition, taps, punctures or burr holes accompanied by drainage procedures

(e.g. hematoma, abscess, cyst, etc.) followed by other procedures, are not
separately reported unless performed as staged procedures.
 Modifier —58 may be used to indicate staged or planned services.

Surgery of Skull Base 61580
The codes are categorized according to
(1) approach procedure necessary to obtain adequate exposure of the lesion

(pathologic entity),
(2) definitive procedure(s) necessary to biopsy, excise or otherwise treat the

lesion, and
(3) repair/reconstruction of the defect present following the definitive

procedure(s).
Surgery of Skull Base
 The approach procedure is described according to anatomical area involved, i.e.,
anterior cranial fossa, middle cranial fossa, posterior cranial fossa, and brain
stem or upper spinal cord.
 The definitive procedure(s) describes the repair, biopsy, resection, or excision of

various lesions of the skull base and, when appropriate, primary closure of the
dura, mucous membranes, and skin.
 The repair/reconstruction procedure(s) is reported separately if extensive dural

grafting, cranioplasty, local or regional myocutaneous pedicle flaps, or extensive
skin grafts are required.
Points to remember
 When one surgeon provides the approach procedure, another surgeon performs
the definitive procedure(s), and another surgeon the repair/reconstruction
procedure(s), each surgeon reports only the code for the specific procedure
performed.
 If one surgeon provides more than 1 procedure, report the second one with 51
modifier.
Surgery for Aneurysm, Arteriovenous Malformation, or Vascular Disease
TERMS PRESENT:
 Aneurysm: Weakening of an arterial blood vessel wall, resulting in a dilated

outpouching from the weak-walled vessel, rendering it susceptible to rupture.
 Arteriovenous Malformation (AVM): AVM is a tumor-like growth of blood

vessels
 Code pickup is based upon
o Location
o Nature of procedure ( Simple / complex ) or Size of the tumor

Surgery for Aneurysm, Arteriovenous Malformation, or Vascular Disease
Examples:
1) Physician treated complex AVM from supratentorial region.
Answer: 61682
2) The physician treated 19 mm aneurysm in the frontal portion of the skull.
Answer: 61697
Miscellaneous procedures
1) Stereotaxis: Minimally invasive surgical intervention which makes use of a

three- dimensional system to locate small targets inside the body and to perform
on them some action such as ablation (removal), biopsy, lesion, injection, etc.
2) Stereotactic Radiosurgery (Cranial)
Stereotactic Radiosurgery (SRS) or (SRT): Method of treating
disorders with precise delivery of single high dose radiation.

3) Neurostimulators (Intracranial): Cranial neurostimulators consist of

electrodes implanted deep in the brain and a surgically implanted, pacemaker-like
device that delivers preprogrammed intermittent electrical pulses to subcortical sites
(e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular,
periaqueductal gray). Neurostimulators are used to treat functional disorders like
Parkinson's disease, multiple sclerosis, intractable pain, etc
4) Cerebrospinal Fluid (CSF) Shunt Cerebral shunts are commonly used to treat
hydrocephalus, the swelling of the brain due to excess buildup of cerebrospinal fluid
(CSF).
 Locate first beginning and ending of the shunt
 Decide whether to add any additional code for the neuroendoscopy (62160)
 Code reprogramming of programmable CSF shunt separately (62252)
 Assign modifier 78 for maintenance in the global period.

4) Epidural anesthesia
 In the spine, the epidural space is an anatomic space that is the outermost part of
the spinal canal.
 It is the space within the canal (formed by the surrounding vertebrae) lying outside
the dura mater (which encloses the arachnoid mater, subarachnoid space, the
cerebrospinal fluid, and the spinal cord).
 The term epidural is a simplified and all-inclusive term often used to refer to
techniques such as epidural analgesia and epidural anesthesia.
4) Epidural anesthesia
 The epidural route is frequently employed to administer diagnostic and therapeutic

chemical substances, as well as certain analgesic and local anesthetic agents.
 Epidural techniques frequently involve injection of drugs through a catheter placed

into the epidural space. The injection can result in a loss of sensation (including the
sensation of pain) by blocking the transmission of signals through nerves in or near
the spinal cord. Injections for myelography all include radiological supervision and
interpretation.
EXAMPLES:
1) Neurosurgeon places a ventricular CSF shunt routed to the jugular using the
neuroendoscope.
Answer: 62220 and 62160
2) Patient presented to the clinic for replacement of ventricular catheter.
Answer: 62225
EXAMPLES:
3) What is the CPT code for injection of an anesthetic agent into the greater
occipital nerve?
Answer: 64405
4) What is the CPT code for laminectomy for biopsy of intraspinal neoplasm,
intradural, intramedullary, cervical?
Answer: 63285
EXAMPLES:
5) What is the CPT code for stereotactic aspiration of an intracranial lesion?
Answer: 61750

Nervous System

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NERVOUS SYSTEM

Procedural Terms – Definitions:

 Craniectomy: Surgical removal of a portion of the cranium; elevated flap to do

 Craniotomy: Any operation on the cranium or incision into the cranium;

 A burr hole is often necessary in anticipation for intracranial surgery (e.g.

 In addition, taps, punctures or burr holes accompanied by drainage procedures

 Modifier —58 may be used to indicate staged or planned services.

(1) approach procedure necessary to obtain adequate exposure of the lesion

(2) definitive procedure(s) necessary to biopsy, excise or otherwise treat the

(3) repair/reconstruction of the defect present following the definitive

 The definitive procedure(s) describes the repair, biopsy, resection, or excision of

 The repair/reconstruction procedure(s) is reported separately if extensive dural

 Aneurysm: Weakening of an arterial blood vessel wall, resulting in a dilated

 Arteriovenous Malformation (AVM): AVM is a tumor-like growth of blood

 Code pickup is based upon

o Nature of procedure ( Simple / complex ) or Size of the tumor

1) Physician treated complex AVM from supratentorial region.

2) The physician treated 19 mm aneurysm in the frontal portion of the skull.

1) Stereotaxis: Minimally invasive surgical intervention which makes use of a

2) Stereotactic Radiosurgery (Cranial)

Stereotactic Radiosurgery (SRS) or (SRT): Method of treating

disorders with precise delivery of single high dose radiation.

3) Neurostimulators (Intracranial): Cranial neurostimulators consist of

 Locate first beginning and ending of the shunt

 Code reprogramming of programmable CSF shunt separately (62252)

 Assign modifier 78 for maintenance in the global period.

 The epidural route is frequently employed to administer diagnostic and therapeutic

 Epidural techniques frequently involve injection of drugs through a catheter placed

Answer: 62220 and 62160

2) Patient presented to the clinic for replacement of ventricular catheter.

5) What is the CPT code for stereotactic aspiration of an intracranial lesion?

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