CPT® Code 61863

Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array

The procedure described by CPT® Code 61863 involves the implantation of a neurostimulator electrode array in the subcortical regions of the brain, which are critical areas for managing various functional disorders. This procedure is particularly relevant for patients suffering from conditions such as Parkinson's disease, tremors, multiple sclerosis, and medically intractable primary dystonias. It also addresses symptoms related to psychotropic medications, including bradykinesia, dyskinesia, rigidity, and severe pain associated with cancer or other causes. The implantation is performed using a stereotactic approach, which allows for precise targeting of the brain's subcortical structures, such as the thalamus, globus pallidus, subthalamic nucleus, periventricular area, and periaqueductal gray. To initiate the procedure, a stereotactic frame is securely attached to the patient's skull, ensuring stability and accuracy during the operation. Imaging techniques, such as MRI or CT scans, are employed to meticulously map the brain and identify the optimal locations for electrode array placement. The number of arrays to be implanted and their specific trajectories are determined based on this imaging data. Access to the implantation sites is achieved through twist drill holes or burr holes, which are localized and marked on the skin before incising it. The procedure may also involve a craniotomy or craniectomy, where scalp flaps are developed, burr holes are drilled, and the bone is cut to create a bone flap or remove a portion of the skull. Once the dura mater is opened, the brain surface is exposed, allowing for the careful insertion of a guide cannula into the targeted area. The deep brain stimulation array is then positioned, and test stimulation is conducted to ensure optimal placement and functionality. After confirming the desired results, the guide cannula is removed, and the electrode array is anchored in place. The procedure concludes with the closure of the galea and skin, followed by the removal of the stereotactic frame. This comprehensive approach ensures that the neurostimulator array is accurately placed to provide therapeutic benefits for the patient.