How To Use CPT Code 61690

CPT 61690 describes a surgical procedure for the removal of an arteriovenous malformation (AVM) from the dura mater of the brain. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 61690?

CPT 61690 is used to describe a surgical procedure in which a portion of the skull bone is removed and an arteriovenous malformation (AVM) is resected from the dura mater of the brain. This procedure is specifically for simple AVMs that are easily accessible, without deep venous drainage, and do not involve areas of the cortex that relate to senses, speech, and language.

2. Official Description

The official description of CPT code 61690 is: ‘Surgery of intracranial arteriovenous malformation; dural, simple.’

3. Procedure

1. The provider makes an incision in the scalp above the area where the arteriovenous malformation is located.
2. A circular portion of bone is removed using a burr hole or another method.
3. The provider gains access to the arteriovenous malformation in the dura mater, the thick outer covering of the brain.
4. The AVM is separated from the surrounding brain tissue and resected.
5. Excess fluid or blood is drained using a drain, if necessary.
6. The layers of dural tissue are sutured together.
7. The bone flap may be reattached using plates, wires, or sutures.
8. The wound is covered with a sterile dressing.

4. Qualifying circumstances

CPT 61690 is performed on patients with a simple arteriovenous malformation (AVM) that is easily accessible, without deep venous drainage, and does not involve areas of the cortex that relate to senses, speech, and language. The procedure is typically performed by a provider who specializes in neurosurgery or a related field.

5. When to use CPT code 61690

CPT code 61690 should be used when performing surgery to remove a simple arteriovenous malformation (AVM) from the dura mater of the brain. It should not be used for complex AVMs or for procedures involving other areas of the skull, meninges, or brain.

6. Documentation requirements

To support a claim for CPT 61690, the provider must document the following information:

• Patient’s diagnosis of a simple arteriovenous malformation (AVM)
• Description of the procedure performed, including the specific techniques used
• Date of the surgery
• Any complications or unexpected findings during the procedure
• Details of the closure and wound care
• Signature of the provider performing the surgery

7. Billing guidelines

When billing for CPT 61690, ensure that the procedure meets the criteria for a simple arteriovenous malformation (AVM) and that it is performed on the dura mater of the brain. It should not be reported with other codes for aneurysm, vascular disease, or procedures on the skull, meninges, or brain. Additional guidelines may vary depending on the payer and specific circumstances of the procedure.

8. Historical information

CPT 61690 was added to the Current Procedural Terminology system on January 1, 1990. The code was later added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A neurosurgeon performing surgery to remove a simple arteriovenous malformation (AVM) from the dura mater of the brain.
2. A neurologist resecting an easily accessible AVM without deep venous drainage from the dura mater of the brain.
3. A neurosurgeon removing a small, simple AVM from the dura mater of the brain using a burr hole.
4. A neurosurgeon performing surgery to resect a simple AVM from the dura mater of the brain, ensuring it does not involve areas of the cortex related to speech and language.
5. A neurosurgeon removing a simple AVM from the dura mater of the brain and reattaching the bone flap using sutures.
6. A neurosurgeon performing surgery to remove a simple AVM from the dura mater of the brain, draining excess fluid or blood using a drain.
7. A neurosurgeon resecting a simple AVM from the dura mater of the brain and suturing the layers of dural tissue together.
8. A neurosurgeon removing a simple AVM from the dura mater of the brain and covering the wound with a sterile dressing.
9. A neurosurgeon performing surgery to remove a simple AVM from the dura mater of the brain, documenting any complications or unexpected findings during the procedure.
10. A neurosurgeon resecting a simple AVM from the dura mater of the brain and providing post-operative instructions for wound care.