2025 CPT code 61705

Surgery of aneurysm, vascular malformation, or carotid-cavernous fistula by intracranial and cervical occlusion of carotid artery.

Includes craniotomy when appropriate. Not to be used for injection procedures for cerebral angiography, ventriculography, or pneumoencephalography (refer to specific codes for these procedures).

Modifiers such as 22 (Increased Procedural Services), 51 (Multiple Procedures), 59 (Distinct Procedural Service), etc. may be applicable based on specific circumstances.

Medical necessity is established by the presence of an intracranial aneurysm, vascular malformation, or carotid-cavernous fistula requiring surgical intervention, and the need for a combined intracranial and cervical approach for effective treatment.

The neurosurgeon performs the craniotomy, exposes the brain, identifies the vascular anomaly, temporarily occludes the cervical carotid artery, and ligates the affected vessel intracranially.They also ensure hemostasis and close the surgical site.

IMPORTANT Related codes include 61708 (intracranial electrothrombosis) and 61710 (intra-arterial embolization or balloon catheter).

In simple words: The surgeon opens the skull to reach the abnormal blood vessel in the brain.They temporarily block blood flow in the neck artery leading to the brain, then seal off the abnormal vessel in the brain to prevent rupture or further bleeding. After ensuring there is no bleeding, the skull is closed.

This procedure involves a craniotomy to access the intracranial aneurysm, vascular malformation, or carotid-cavernous fistula. The cervical carotid artery is temporarily clamped, and the artery proximal and distal to the lesion is ligated to stop blood flow to the lesion.The cervical carotid is then unclamped, and the surgical site is monitored for bleeding. This procedure combines intracranial and cervical approaches for occlusion.

Example 1: A patient presents with a ruptured aneurysm in the brain requiring surgical intervention. Code 61705 is used when the surgeon performs both a craniotomy and a temporary cervical carotid occlusion during the repair., A patient has a carotid-cavernous fistula caused by trauma.The surgeon uses both intracranial and cervical approaches to occlude the fistula, making 61705 the appropriate code., A patient with a complex vascular malformation deep within the brain requires surgical intervention. To control blood flow effectively, the surgeon performs a craniotomy and temporary cervical occlusion during the complex repair procedure.

Documentation should include operative report detailing the craniotomy, temporary cervical carotid occlusion, ligation of the vessel, method of hemostasis, and closure.The medical necessity for this combined approach, including the location and type of vascular anomaly, should also be clearly documented.

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