CPT® Code 0398T

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Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation lesion, intracranial for movement disorder including stereotactic navigation and frame placement when performed

The procedure described by CPT® Code 0398T involves a non-invasive technique known as Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS). This advanced method is utilized for the stereotactic ablation of intracranial lesions, specifically targeting movement disorders such as essential tremor and Parkinson’s disease. The process begins with the preparation of the patient's scalp, which includes shaving the hair and inspecting the area for any scars or lesions that may interfere with the transmission of ultrasound waves. To facilitate precise targeting, four pins are inserted into the scalp, and a stereotactic frame is affixed low on the head, ensuring that the brain is accurately positioned within the treatment window. A silicone membrane is then placed over the scalp, which is filled with cool, degassed water at approximately 18°C. This cooling mechanism is crucial as it protects the external tissues and bone from potential burns caused by the ultrasound waves. The patient is positioned on the MRI table, and a specialized helmet containing the ultrasound transducer is secured over the silicone membrane, as well as the frame, to the MRI machine. Comprehensive MRI sequences are conducted to capture images of the entire brain and the specific target areas for treatment. These images, along with the treatment plan, are meticulously reviewed by the surgeon to ensure accuracy and effectiveness. A software program is employed to calculate the necessary treatment parameters, and the procedure commences with the generation of focused ultrasound energy from the helmet transducer, which creates a process known as sonication. Throughout the procedure, Magnetic Resonance Thermometry Imaging is utilized to provide real-time temperature maps, allowing for continuous monitoring to confirm that the lesions are being adequately treated. Notably, the patient remains awake during the entire process, enabling them to provide clinical feedback to the surgeon. Upon completion of the procedure, the patient is carefully uncoupled from the helmet and frame and subsequently removed from the MRI scanner. It is important to note that CPT® Code 0398T encompasses the stereotactic navigation and frame placement associated with the MRgFUS intracranial lesion ablation when these components are performed.