How To Use CPT Code 61534

CPT 61534 describes the procedure of craniotomy with elevation of bone flap for the excision of an epileptogenic focus without electrocorticography during surgery. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 61534?

CPT 61534 is used to describe a surgical procedure in which a portion of the skull bone flap is elevated to remove an epileptogenic focus, an area of the brain that generates seizure-causing electrical impulses. Unlike other procedures, this code does not involve the use of electrocorticography, which is the recording of the electrical activity of the brain.

2. Official Description

The official description of CPT code 61534 is: ‘Craniotomy with elevation of bone flap; for excision of epileptogenic focus without electrocorticography during surgery.’

3. Procedure

1. The provider begins by making an incision in the scalp over the target area in the brain where the epileptic focus is localized.
2. Next, the provider folds back the tissue to expose the bone and uses a surgical drill, saw, and a tool with a footplate to protect the dura.
3. Multiple burr holes are created in the skull, and the provider cuts between adjacent holes to create a bone flap.
4. The provider then elevates the portion of the skull bone to expose the dura.
5. After opening the dura, the provider removes previously placed electrodes from the area.
6. The provider proceeds to excise the tissue of the brain from which the patient’s epileptic seizures originate.
7. Finally, the bone flap is reattached to its original position using plates, wires, or sutures, and the wound is covered with a sterile dressing.

4. Qualifying circumstances

CPT 61534 is performed on patients with a well-localized epileptic focus in the brain that requires surgical excision. The procedure is typically performed by a neurosurgeon or a qualified provider with expertise in craniotomy. It is important to note that this code specifically applies to cases where electrocorticography is not utilized during the surgery.

5. When to use CPT code 61534

CPT code 61534 should be used when a craniotomy with elevation of bone flap is performed to excise an epileptogenic focus without the use of electrocorticography. If electrocorticography is utilized during the surgery, a different code, such as CPT 61536, should be used instead.

6. Documentation requirements

To support a claim for CPT 61534, the provider must document the following information:

• Patient’s diagnosis and the need for surgical excision of the epileptogenic focus
• Details of the surgical procedure, including the specific approach used and any modifications made
• Date of the surgery and the duration of the procedure
• Any additional procedures performed during the surgery
• Any complications or unexpected findings encountered during the surgery
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 61534, ensure that the procedure meets the specific criteria outlined in the code description. It is important to accurately document the absence of electrocorticography during the surgery. Additionally, be aware of any specific payer guidelines or requirements for reporting this code.

8. Historical information

CPT 61534 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone no updates since its addition. However, it is worth noting that as of 2017, this procedure is listed under the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A neurosurgeon performs a craniotomy with elevation of bone flap to excise an epileptogenic focus in a patient’s brain, without the use of electrocorticography.
2. A patient with medically refractory epilepsy undergoes a craniotomy with elevation of bone flap to remove an epileptogenic focus, following unsuccessful attempts at seizure control with medication.
3. A neurosurgical team performs a craniotomy with elevation of bone flap to excise an epileptogenic focus in a pediatric patient with intractable seizures.
4. A patient with a well-localized epileptic focus undergoes a craniotomy with elevation of bone flap to remove the source of their seizures, without the need for electrocorticography.
5. A neurosurgeon performs a craniotomy with elevation of bone flap to excise an epileptogenic focus in a patient with drug-resistant epilepsy, aiming to improve their quality of life.
6. A provider performs a craniotomy with elevation of bone flap to remove an epileptogenic focus in a patient with focal seizures, without the use of electrocorticography.
7. A patient with a history of recurrent seizures undergoes a craniotomy with elevation of bone flap to remove an epileptogenic focus, following a comprehensive evaluation and diagnostic workup.
8. A neurosurgeon performs a craniotomy with elevation of bone flap to excise an epileptogenic focus in a patient with refractory epilepsy, aiming to reduce the frequency and severity of their seizures.
9. A patient with a well-defined epileptic focus undergoes a craniotomy with elevation of bone flap to remove the source of their seizures, without the need for electrocorticography.