Epilepsy Surgery is a type of brain surgery that aims to reduceepileptic seizures. It is a procedure that removes an area of the brain where seizures occur. This surgical procedure tends to be more effective when seizures always occur in a single location in the brain. Epilepsy surgery may not always be the first line of treatment. It may be an option when medications fail to control seizure symptoms. The specific effectiveness of the surgery varies and may depend on the type of seizures that a person experiences and the specific surgical procedure. Neurologists or other specialists performing an epilepsy procedure need to correctly understand the usage of the procedure codes and their potential impact on patient care. Relying on the services of a professional neurology medical billing company with ample expertise in this field is the perfect option for physicians to ensure billing and coding efficiency.

Why Is Epilepsy Surgery Done?

As mentioned above, epilepsy surgery may be an option when medicines don’ t control seizures. The procedure is mainly done to stop seizures or limit the severity of seizures. It is also done to reduce seizure-related deaths, decrease the use of anti-seizure medications and reduce the possible side effects of the medicines. If left uncontrolled, epilepsy can lead to several complications and health risks such as physical injuries during a seizure, depression and anxiety, developmental delays in children and worsening memory or other thinking skills.

Typically, epileptic seizures result from irregular activity of brain cells called neurons. The type of surgery needed depends on the location of the neurons that start the seizure and the age of the patient. There are different types of epilepsy surgery such as – resective surgery, deep brain stimulation, corpus callosotomy, hemispherectomy,laser interstitial thermal therapy (LITT) and functional hemispherectomy. According to the Epilepsy Society, 70 percent of people who have temporal lobe surgery become seizure-free, with 50 percent remaining seizure-free after 10 years. However, neurologists will only recommend epilepsy surgery for those whom they expect to benefit from it.

Preparing for an Epilepsy Surgery

Before performing an epilepsy surgery, a neurologist will perform several tests such as – where in the brain the seizures originate, the areas of the brain to which the seizures spread, whether surgery would affect important brain functions – to determine whether someone is a suitable candidate for epilepsy surgery. In addition, several other standard tests such as -Baseline electroencephalogram (EEG), Magnetic resonance imaging (MRI), Positron emission tomography (PET), Single-photon emission computerized tomography (SPECT), Functional MRI, Brain mapping, Magnetoencephalography (MEG) and Neuropsychological tests may be used to identify the source of irregular brain activity.

Usually, epilepsy surgery is performed under general anesthesia. As part of the procedure, the surgeon creates a relatively small window in the skull, depending on the type of surgery. After completion of the surgical procedure, the bone is replaced and fastened to the remaining skull for healing.The outcomes of epilepsy surgery vary depending on the type of surgery performed. In most cases, the expected outcome is seizure control with medication. Soon after the surgery, the patient will be placed in the intensive care unit for careful monitoring. Most people may need to consume pain medications during the initial days. Post-operative swelling and pain can be expected soon after the surgery, which may resolve after some weeks.

CPT Codes for Reporting Epilepsy Surgery

Billing and coding for epilepsy surgery can be challenging, as it involves numerous rules related to reporting the procedure accurately. Physicians administering this surgical procedure must use the relevant CPT codes to bill for the procedure correctly. The CPT codes for epilepsy surgery include –

• 61534 Craniotomy with elevation of bone flap; for excision of epileptogenic focus without electrocorticography during surgery
• 61536 for excision of epileptic focus, with electrocorticography during surgery
• 61537 for lobectomy, temporal lobe, without electrocorticography during surgery
• 61538 for lobectomy with electrocorticography during surgery, temporal lobe
• 61541 for transection of corpus callosum
• 61543 for partial or subtotal hemispherectomy
• 61566 Craniotomy with elevation of bone flap; for selective amygdalohippocampectomy
• 61863 -61864 – Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g. thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording
• 61867 – 61868 – Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording
• 61880 Revision or removal of intracranial neurostimulator electrodes [covered for intractable seizures]
• 61885 – 61886 – Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling
• 95836 Electrocorticogram from an implanted brain neurostimulator pulse generator/transmitter, including recording, with interpretation and written report, up to 30 days [covered for intractable seizures]
• 95958 Wada activation test for hemispheric function, including electroencephalographic (EEG) monitoring
• 95970 -95971 – Electronic analysis of implanted neurostimulator pulse generator system (e.g. rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements)
• 95976 -95977 – Electronic analysis of implanted neurostimulator pulse generator/transmitter (e.g. contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified healthcare professional
• 95978 Electronic analysis of implanted neurostimulator pulse generator system (e.g. rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour [covered for intractable seizures]
• 95983 Electronic analysis of implanted neurostimulator pulse generator/transmitter (e.g. contact group [s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified healthcare professional; with brain neurostimulator pulse generator/ transmitter programming, first 15 minutes face-to-face time with physician or other qualified healthcare professional [covered for intractable seizures]
• 95984 Electronic analysis of implanted neurostimulator pulse generator/transmitter (e.g. contact group [s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified healthcare professional; with brain neurostimulator pulse generator/ transmitter programming, first 15 minutes face-to-face time with physician or other qualified healthcare professional [covered for intractable seizures]

HCPCS Codes

• G0339 Image guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session, or first session of fractionated treatment
• G0340 Image guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum 5 sessions per course of treatment
• L 8680 Implantable neurostimulator electrode, each
• L8681 Patient programmer (external) for use with implantable programmable implantable neurostimulator pulse generator
• L 8682 Implantable neurostimulator radiofrequency receiver
• L8683 Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver
• L 8685 Implantable neurostimulator pulse generator, single array, rechargeable, includes extension
• L8688 Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension
• L 8689 External recharging system for battery (internal) for use with implantable neurostimulator
• L 8695 External recharging system for battery (external) for use with implantable neurostimulator
• S2142 Cord blood-derived stem cell transplantation, allogenic
• S2150 Bone marrow or blood-derived stem cells (peripheral or umbilical), allogenic or autologous, harvesting, transplantation, and related complications; including pheresis and cell preparation/storage; marrow ablative therapy; drugs, supplies, hospitalization with outpatient follow-up; medical/surgical, diagnostic, emergency, and rehabilitative services; and the number of days of pre- and post-transplant care in the global definition

All types of epilepsy surgeries involve a certain amount of risk and complications such as – infection, bleeding, adverse reactions to anesthesia and scarring. In addition, there may be a risk of changes in brain function. Depending on the type of surgery, these can include changes to vision, thinking skills, personality, and mood. These types of risks can vary among individuals, and in certain people, they may only be temporary and improve after the swelling from surgery resolves.

Billing and coding for neurology conditions can be complex. Outsourcing medical billing tasks to professional companies can help to submit accurate claims. Reputable billing and coding companies will offer the services of expert coders who are well-versed in the latest coding and billing guidelines.