CPT® Code 61864

Add-On Code

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; each additional array (List separately in addition to primary procedure)

The procedure described by CPT® Code 61864 involves the implantation of a neurostimulator electrode array in the subcortical regions of the brain, which includes areas such as the thalamus, globus pallidus, subthalamic nucleus, periventricular region, and periaqueductal gray. This intervention is primarily indicated for the treatment of various functional disorders, including those associated with Parkinson's disease, different types of tremors, multiple sclerosis, and medically intractable primary dystonias. It is also applicable for conditions resulting from psychotropic medications, as well as symptoms like bradykinesia, dyskinesia, rigidity, and severe pain due to cancer or other underlying causes. The procedure utilizes a stereotactic frame that is securely attached to the patient's skull, allowing for precise targeting of the brain regions where the electrode arrays will be implanted. Preoperative imaging techniques, such as MRI or CT scans, are employed to meticulously map the brain and determine the optimal locations and trajectories for the electrode placements. During the procedure, 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. In cases where a more extensive approach is required, a craniotomy or craniectomy may be performed, involving the development of scalp flaps and the drilling of burr holes to access the underlying bone. The dura mater is then coagulated and punctured to expose the brain surface. The entry site for the guide cannula is carefully inspected to avoid large vessels, and the brain surface is coagulated to facilitate the insertion of the guide cannula. Once in place, the deep brain stimulation array is introduced and positioned within the targeted area, followed by test stimulation to ensure optimal placement and functional results. After the procedure, the guide cannula is removed, and an anchoring device is utilized to secure the electrode array. If multiple arrays are implanted, the procedure is repeated as necessary. Finally, the galea and skin are closed, and the stereotactic frame is removed, completing the implantation process.