CAM 70139

Stereotactic Electroencephalography

Category:Surgery   Last Reviewed:March 2020
Department(s):Medical Affairs   Next Review:March 2999
Original Date:March 1996    

Description:
Stereotactic electroencephalography (SEEG) is an invasive procedure. The depth electrodes are implanted through burr holes in the skull. SEEG is used to localize a seizure focus in patients who are candidates for surgery.


Policy:
Stereotactic electroencephalography is considered MEDICALLY NECESSARY on a prior approval basis when ALL three of these conditions are fulfilled:

  • The patient’s seizures are intractable to medical therapy.
  • Prior diagnostic studies suggest, but do not confirm, the presence of a localized seizure focus.
  • The seizure focus is located in an area of the brain amenable to surgical resection.

Coding Section

Codes Number Description
CPT 61760 Stereotactic implantation of depth electrodes into cerebrum for long-term seizure monitoring
ICD-9 Procedure  02.93 Implantation of intracranial neurostimulator
  88.14 Electroencephalogram
ICD-9 Diagnosis 780.3 Convulsions, 345.00-345.91 epilepsy code range
HCPCS A4556 Electrodes
ICD-10-CM (effective 10/01/15)  R5600  Simple febrile convulsions
  R5601  Complex febrile convulsions 
  R561  Post-traumatic seizures
  R569  Unspecified convulsions
ICD-10-PCS (effective 10/01/15)  00H00MZ  Insertion of Neurostimulator Lead into Brain, Open Approach 
  00H03MZ Insertion of Neurostimulator Lead into Brain, Percutaneous Approach 
  00H04MZ  Insertion of Neurostimulator Lead into Brain, Percutaneous Endoscopic Approach 
  00H60MZ  Insertion of Neurostimulator Lead into Cerebral Ventricle, Open Approach 
  00H63MZ  Insertion of Neurostimulator Lead into Cerebral Ventricle, Percutaneous Approach 
  00H64MZ  Insertion of Neurostimulator Lead into Cerebral Ventricle, Percutaneous Endoscopic Approach 
  BW110ZZ  Fluoroscopy of Abdomen and Pelvis using High Osmolar Contrast 
  BW111ZZ  Fluoroscopy of Abdomen and Pelvis using Low Osmolar Contrast 
  BW11YZZ  Fluoroscopy of Abdomen and Pelvis using Other Contrast 
  BW11ZZZ  Fluoroscopy of Abdomen and Pelvis 
Type of Service Medical/Diagnostic  
Place of Service Inpatient  

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross and Blue Shield Association technology assessment program (TEC) and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology© American Medical Association.  All Rights Reserved" 

History From 2014 Forward     

03/02/2020 

Annual review. No change to policy intent. 

03/04/2019 

Annual Review. No change to policy intent. 

03/19/2018 

Annual Review. No change to policy intent. 

03/01/2017 

Annual review.  No change to policy intent 

03/10/2016 

Annual review.  No change to policy intent 

09/23/2015 

Added ICD-10 codes to policy. 

03/05/2015 

Annual review.  Added coding.

03/03/2014

Annual review. No changes made.

 


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