2025 CPT code 62120
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Repair of encephalocele, skull vault, including cranioplasty.
Modifiers such as 22 (increased procedural services), 51 (multiple procedures), and others may be applicable depending on the specific circumstances of the case.Refer to the CPT guidelines for modifier usage.
Medical necessity for this procedure is established by the presence of a symptomatic encephalocele, potential for neurological compromise, or risk of infection from exposed neural tissue.The size and location of the encephalocele and any associated neurological deficits will influence the decision to proceed with surgery.
The neurosurgeon is primarily responsible for this procedure. Responsibilities include pre-operative assessment, surgical planning, performing the craniotomy and repair of the encephalocele and skull defect, and post-operative care.
In simple words: The doctor repairs a brain bulge (encephalocele) that's pushing through a hole in the skull. They make an incision, carefully move the brain tissue, remove a piece of the skull to access the bulge, and then fix the hole and put everything back in place.The skull is then closed.
This procedure involves repairing a brain herniation (encephalocele) through a skull defect.The surgeon makes a scalp incision, separates the herniated brain tissue from the scalp, removes a section of the skull (bone flap) to access the encephalocele. Nonfunctional brain tissue is removed, and remaining brain tissue, membranes, and fluids are returned to the skull. The encephalocele sac is removed, the dura is closed with sutures, and a synthetic graft or sealant may be used. The bone flap is replaced, the skull is closed, and the scalp is sutured.
Example 1: A newborn presents with an encephalocele at the occipital region. The neurosurgeon performs a craniotomy to repair the defect, resecting non-viable neural tissue and closing the dural defect. The bone flap is replaced, and the scalp is closed., A child with a history of trauma suffers a skull fracture with resultant encephalocele.The neurosurgeon repairs the fracture, resects damaged brain tissue, and reconstructs the skull using titanium plates and screws., An adult patient is diagnosed with a small encephalocele covered by normal skin. The neurosurgeon elects to perform a minimally invasive procedure to repair the defect through an endoscopic endonasal approach.
* Preoperative imaging (CT scan, MRI) demonstrating the encephalocele and extent of the skull defect.* Operative report detailing the surgical technique, tissue resection, and reconstruction.* Postoperative imaging (CT scan) to assess surgical outcomes.* Pathology report if any tissue was sent for analysis.* Complete neurological examination documentation before and after the procedure.
** The complexity of the repair will depend on the size and location of the encephalocele, presence of associated anomalies, and the need for additional procedures (e.g., shunt placement for hydrocephalus).
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: This information is not available in the provided text.Consult the official CPT codebook or a relevant fee schedule for RVU values.
- Global Days : The global period for this procedure is not specified in the provided text. Refer to the CPT codebook or payer-specific guidelines for the applicable global period.
- Payment Status: Active
- Modifier TC rule: TC modifier application will depend on the individual circumstances of the surgery; consult the appropriate guidelines.
- Fee Schedule : This information is not available in the provided text. Consult historical CPT fee schedules or payer-specific data for historical fee information.
- Specialties:Neurosurgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center