2025 CPT code 61692
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Surgical resection of a complex intracranial arteriovenous malformation (AVM) located in the dura mater, exceeding 3cm, with potential deep venous drainage or cortical involvement.
Modifiers may be applicable based on the specific circumstances of the procedure. Consult the CPT manual and NCCI edits for appropriate modifier usage.
Surgical resection is medically necessary for symptomatic dural AVMs to prevent hemorrhage, reduce neurological deficits, and improve patient outcomes.The medical necessity should be supported by the patient's clinical presentation, imaging findings, and risk assessment.
Neurosurgeon
In simple words: This brain surgery removes a cluster of abnormal blood vessels (AVM) from the brain's outer covering.It's used for large, complex AVMs that may cause bleeding or affect important brain areas. The surgeon removes part of the skull to reach the AVM, removes it carefully, and then repairs the skull and scalp.
This surgical procedure involves the removal of a portion of the skull bone (craniotomy) to access and resect a complex arteriovenous malformation (AVM) situated in the dura mater of the brain.The AVM is characterized by its size (greater than 3 cm), potential involvement of deep venous drainage (increasing the risk of bleeding), or proximity to cortical areas responsible for sensory, speech, and language functions.Pre-operative angiography is performed to precisely locate the AVM.After scalp incision and creation of a bone flap, the surgeon accesses the AVM, meticulously dissects it from surrounding brain tissue, and resects the abnormal vessels while carefully controlling bleeding.Any excess fluid or blood is drained, and dural layers are sutured. The bone flap may be repositioned using plates, wires, or sutures, and the wound is closed with a sterile dressing.
Example 1: A 55-year-old patient presents with headaches and neurological deficits.Angiography reveals a large (4cm), complex dural AVM with deep venous drainage.Code 61692 is used for the surgical resection., A 40-year-old patient experiences a hemorrhagic stroke due to a 3.5cm dural AVM involving eloquent cortical areas.Emergency craniotomy and resection (61692) are performed to stop the bleeding and minimize neurological damage., A 60-year-old patient has a smaller (3.2cm) dural AVM with limited venous drainage, but it is located in a surgically challenging region near critical brain structures.Due to complexity, 61692 is selected for the procedure.
** This code should only be used for complex dural AVMs exceeding 3 cm, with specific considerations for deep venous drainage or cortical involvement.Precise documentation is essential to justify code selection and ensure proper reimbursement.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: This information requires access to specific payer fee schedules and may vary based on geographical location and other factors.Consult your local Medicare Administrative Contractor (MAC) or other relevant payer for current RVU values and reimbursement rates.
- Global Days : The global surgical period for this procedure will depend on payer-specific guidelines and may vary.It is essential to consult the individual payer's policies for the precise global period.
- Payment Status: Active
- Modifier TC rule: The application of a Technical Component (TC) modifier may depend on the specific setting and payer requirements.Refer to individual payer's guidelines.
- Fee Schedule : Historical fee schedule data is not readily available and requires access to specific payer databases and historical fee information.
- Specialties:Neurosurgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center