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CPT® Code 61470 refers to a surgical procedure known as a craniectomy, specifically a suboccipital craniectomy performed for the purpose of conducting a medullary tractotomy. A tractotomy is a neurosurgical intervention that involves the division or cutting of a nerve tract within the brain or spinal cord. This procedure is primarily indicated for the management of intractable pain, particularly nociceptive pain associated with conditions such as head and neck cancer. The medullary tractotomy aims to alleviate severe facial and neck pain by interrupting pain pathways in the brain. During the procedure, the patient is positioned sitting to optimize access to the medulla oblongata, which is the target area for intervention. The surgical approach involves creating a midline incision at the lower part of the skull to expose the occiput, followed by the creation of burr holes and a bone flap to access the medulla oblongata. This procedure is significant as it provides a means to achieve complete analgesia in the distribution of the trigeminal nerve and other cranial nerves, thereby addressing debilitating pain symptoms. It is important to note that while open tractotomy procedures like this one have been largely supplanted by less invasive techniques such as stereotactic tractotomy, they remain a critical option for certain patients with severe pain conditions.
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The procedure described by CPT® Code 61470 is indicated for the treatment of severe facial and neck pain, particularly in cases where the pain is intractable and associated with conditions such as head and neck cancer. The following specific indications apply:
The surgical steps involved in CPT® Code 61470 are as follows:
Post-procedure care following a craniectomy for medullary tractotomy involves monitoring the patient for any complications that may arise from the surgery. Patients are typically observed for neurological function and signs of infection at the surgical site. Pain management strategies will be implemented to ensure patient comfort as they recover from the procedure. The expected recovery period may vary depending on individual patient factors, but close follow-up is essential to assess the effectiveness of the pain relief achieved through the procedure. Additionally, rehabilitation services may be recommended to support the patient's recovery and adaptation following surgery.
| Short Descr | INCISE SKULL FOR SURGERY | Medium Descr | CRANIECTOMY SUBOCCIPITAL MEDULLARY TRACTOTOMY | Long Descr | Craniectomy, suboccipital; for medullary tractotomy | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 9 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | Not applicable/unspecified. | CCS Clinical Classification | 1 - Incision and excision of CNS |
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| 2015-01-01 | Deleted | Code deleted |
| Pre-1990 | Added | Code added. |
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