How To Use CPT Code 61791

CPT 61791 describes the creation of a lesion in the trigeminal medullary tract of the brainstem using a percutaneous stereotactic method and a neurolytic agent. 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 61791?

CPT 61791 can be used to describe the creation of a lesion in the trigeminal medullary tract of the brainstem using a percutaneous stereotactic method and a neurolytic agent. This code is used when a provider uses a three-dimensional coordinate system to locate small targets inside the brain and makes a lesion in the trigeminal medullary tract using a neurolytic agent such as alcohol, electric current, or radiofrequency.

2. Official Description

The official description of CPT code 61791 is: ‘Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); trigeminal medullary tract.’

3. Procedure

1. The provider identifies the target area of the brain using a three-dimensional coordinate system.
2. A small incision is made through the skin.
3. A hollow needle electrode or other instrument is passed to the target area.
4. A neurolytic agent, such as alcohol, electric current, or radiofrequency, is used to create a lesion in the trigeminal medullary tract of the brainstem.
5. The electrode or instrument is withdrawn, and the skin incision is closed.

4. Qualifying circumstances

Patients eligible to receive CPT 61791 services are those who require the creation of a lesion in the trigeminal medullary tract of the brainstem. This procedure is typically performed for conditions involving temperature and pain sensation. The provider must use a percutaneous stereotactic method and a neurolytic agent, such as alcohol, electric current, or radiofrequency, to create the lesion.

5. When to use CPT code 61791

CPT code 61791 should be used when a provider performs the procedure to create a lesion in the trigeminal medullary tract of the brainstem using a percutaneous stereotactic method and a neurolytic agent. This code should not be used for neurolytic destruction of the trigeminal nerve outside the cranial fossa, which is the base of the cranial cavity.

6. Documentation requirements

To support a claim for CPT 61791, the provider must document the following information:

• Patient’s diagnosis and the need for the creation of a lesion in the trigeminal medullary tract
• Use of a percutaneous stereotactic method
• Specific neurolytic agent used
• Date of the procedure
• Details of the procedure, including the location of the lesion and any complications
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 61791, ensure that the procedure is performed using a percutaneous stereotactic method and a neurolytic agent. It is important to use the appropriate code for neurolytic destruction of the trigeminal nerve outside the cranial fossa (64600-64610) if applicable. Follow the guidelines provided by the payer for reporting CPT 61791 and any associated codes.

8. Historical information

CPT 61791 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A provider using a percutaneous stereotactic method and a neurolytic agent to create a lesion in the trigeminal medullary tract of the brainstem for a patient with chronic facial pain.
2. A neurosurgeon performing a percutaneous stereotactic procedure to create a lesion in the trigeminal medullary tract of the brainstem for a patient with trigeminal neuralgia.
3. An interventional radiologist using a percutaneous stereotactic method and a neurolytic agent to create a lesion in the trigeminal medullary tract of the brainstem for a patient with intractable facial pain.
4. A neurologist performing a percutaneous stereotactic procedure to create a lesion in the trigeminal medullary tract of the brainstem for a patient with cluster headaches.
5. A pain management specialist using a percutaneous stereotactic method and a neurolytic agent to create a lesion in the trigeminal medullary tract of the brainstem for a patient with trigeminal neuropathy.
6. A neurosurgeon performing a percutaneous stereotactic procedure to create a lesion in the trigeminal medullary tract of the brainstem for a patient with glossopharyngeal neuralgia.
7. An interventional radiologist using a percutaneous stereotactic method and a neurolytic agent to create a lesion in the trigeminal medullary tract of the brainstem for a patient with atypical facial pain.