How To Use CPT Code 61450

CPT 61450 describes the procedure of craniectomy, specifically subtemporal craniectomy, for section, compression, or decompression of the sensory root of the gasserian ganglion. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 61450?

CPT 61450 is used to describe a surgical procedure in which a qualified healthcare provider creates an opening in the skull below the temples. This procedure is performed to section, compress, or decompress the sensory root of the gasserian ganglion, a cluster of nerves located at the root of the fifth cranial nerve. The primary purpose of this procedure is to treat facial nerve pain, also known as trigeminal neuralgia.

2. Official Description

The official description of CPT code 61450 is: ‘Craniectomy, subtemporal, for section, compression, or decompression of sensory root of gasserian ganglion.’

3. Procedure

1. The healthcare provider begins by making a right-angle incision in the hairline after the patient is appropriately prepped and anesthetized.
2. Next, the provider divides the muscle from the bone and carefully folds back the tissue to expose the skull.
3. The fibrous membrane covering the external surface of the skull, called the pericranium, is preserved for potential graft use.
4. Burr holes are then drilled into the skull, and a surgical saw, known as a craniotome, is inserted through the burr holes.
5. The provider cuts between adjacent burr holes to create a bone flap, which is then removed to expose the dura, the outermost membrane covering the brain.
6. If necessary, the lower part of the occipital bone may also be removed.
7. The dura is opened, and the provider separates, applies pressure to, or releases pressure on the sensory root or its branches.
8. After completing the necessary procedure, the provider closes the dura, replaces the removed bone, and secures it in place.
9. A temporary drain may be inserted at the surgical site to prevent fluid buildup.
10. Finally, the tissue flap is folded back, the wound is closed with sutures or surgical staples, and the area is dressed.

4. Qualifying circumstances

CPT 61450 is performed on patients who experience facial nerve pain, specifically trigeminal neuralgia, and require sectioning, compression, or decompression of the sensory root of the gasserian ganglion. The procedure is typically carried out by a qualified healthcare provider who has the necessary expertise and training in performing craniectomies. It is important to note that this procedure is not appropriate for all cases of facial nerve pain, and the decision to perform it should be based on a thorough evaluation of the patient’s condition.

5. When to use CPT code 61450

CPT code 61450 should be used when a qualified healthcare provider performs a subtemporal craniectomy to section, compress, or decompress the sensory root of the gasserian ganglion. It is important to ensure that the procedure is medically necessary and appropriate for the patient’s condition. This code should not be used for other types of craniectomies or procedures performed on different areas of the skull.

6. Documentation requirements

To support a claim for CPT 61450, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for the craniectomy procedure
• Details of the procedure performed, including the specific approach used (subtemporal)
• Date of the procedure
• Start and end time of the procedure
• Specific actions taken during the procedure, such as sectioning, compression, or decompression of the sensory root of the gasserian ganglion
• Any additional procedures performed during the same surgical session
• Any complications or unexpected findings
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 61450, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The healthcare provider performing the procedure should have the necessary qualifications and expertise. It is also important to follow any additional guidelines or requirements set forth by the payer or insurance company. CPT code 61450 should not be reported with other codes unless additional procedures were performed during the same surgical session.

8. Historical information

CPT code 61450 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone no updates or changes since its addition. However, it is important to stay updated with any changes or revisions to the code in future editions of the CPT manual.

9. Examples

1. A qualified healthcare provider performs a subtemporal craniectomy to section the sensory root of the gasserian ganglion in a patient with severe trigeminal neuralgia.
2. A patient with facial nerve pain undergoes a subtemporal craniectomy for decompression of the sensory root of the gasserian ganglion.
3. A healthcare provider performs a subtemporal craniectomy to compress the sensory root of the gasserian ganglion in a patient with persistent facial nerve pain.
4. In a case of trigeminal neuralgia, a qualified healthcare provider performs a subtemporal craniectomy to section and decompress the sensory root of the gasserian ganglion.