CPT 61686 Infratentorial AVM Resection Reimbursement | OpenPayer

Summary & Overview

CPT 61686: Resection of Complex Infratentorial Arteriovenous Malformation

CPT code 61686 denotes surgical removal of a complex arteriovenous malformation (AVM) in the infratentorial region of the brain, involving a craniectomy or craniotomy and resection of AVM tissue. This code is used for AVMs typically larger than 3 cm that may have deep venous drainage or involve eloquent cortical areas tied to sensory, speech, or language functions. Nationally, procedures coded with 61686 are high-acuity neurosurgical interventions requiring specialized surgical teams, advanced intraoperative monitoring, and intensive postoperative care.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, expected site-of-service, and the significance of this code for hospital service lines and neurosurgery departments. The publication highlights common billing and documentation themes surrounding complex AVM resections and outlines which payers are included in the benchmarking and policy discussion.

This summary prepares clinicians, coding professionals, and hospital administrators to understand where 61686 fits into clinical practice and billing workflows, what to expect from payer coverage considerations, and which operational areas (surgical suite, neurocritical care) are typically involved. Data not available in the input is explicitly noted where applicable in the full publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare61686CPTneurosurgeryarteriovenous malformationinfratentorialcraniotomyneurocritical-caresurgical-resection

Billing Code Overview

CPT code 61686 describes a neurosurgical procedure in which the surgeon removes a portion of the skull (craniectomy/craniotomy) and resects a complex arteriovenous malformation (AVM) located in the infratentorial region of the brain. The infratentorial region lies below the tentorium cerebelli and includes the cerebellum and brainstem structures. This procedure is intended for complex AVMs, typically greater than 3 cm, which may have deep venous drainage or involve cortical areas related to sensory, speech, or language functions.

Service Type: Neurosurgical resection of complex infratentorial AVM

Typical Site of Service: Inpatient operating room, usually performed at tertiary care centers or academic hospitals with neurosurgical capability and perioperative intensive care.

Clinical & Coding Specifications

Clinical Context

A 46-year-old right-handed patient presents with progressive headache, episodic vertigo, and new onset cerebellar ataxia. MRI and cerebral angiography identify a complex infratentorial arteriovenous malformation (AVM) greater than 3 cm involving the cerebellar hemisphere with deep venous drainage and feeders from the posterior inferior cerebellar artery. After multidisciplinary review, the patient is scheduled for a craniotomy with resection of the infratentorial AVM under general anesthesia. The clinical workflow includes preoperative neurological and anesthetic assessment, intracranial vascular imaging confirmation, consent for potential blood transfusion and staged procedures, intraoperative neurophysiologic monitoring, a suboccipital craniotomy (removal of a portion of skull bone), microsurgical resection of the AVM nidus with preservation of critical brainstem and cerebellar structures, hemostasis, possible vessel bypass or occlusion techniques as needed, and postoperative care in a neurosurgical intensive care unit with repeat imaging to confirm complete resection and to assess for complications such as hemorrhage or infarction. Typical site of service is an inpatient hospital operating room with postoperative ICU stay. Service type is major neurosurgical open procedure for excision of a complex intracranial vascular lesion.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)	Use when none of the supplemental modifiers apply; standard reporting of the procedure.

CPT 61690: Craniectomy and Resection of Simple Dural Arteriovenous Malformation

CPT-61711-EC-IC-BYPASS-MIDDLE-CEREBRAL-CORTICAL-ARTERY

CPT 61711: Extracranial–Intracranial Bypass, Middle Cerebral to Cortical Arteries

CPT-61708-INTRACRANIAL-VASCULAR-LESION-ELECTROCOAGULATION

CPT 61708: Intracranial Vascular Lesion Destruction via Electric Current

CPT-61680-SUPRATENTORIAL-AVM-RESECTION-CRANIOTOMY

CPT 61680: Craniotomy with Resection of Supratentorial AVM

CPT-61698-INTRACRANIAL-VERTEBROBASILAR-ANEURYSM-REPAIR

CPT 61698: Intracranial Vertebrobasilar Aneurysm Repair

CPT-61700-INTRACRANIAL-ANEURYSM-REPAIR-INTERNAL-CAROTID-CIRCULATION

CPT 61700: Intracranial Aneurysm Repair, Internal Carotid Circulation

CPT-61682-COMPLEX-SUPRATENTORIAL-AVM-RESECTION-CRANIOTOMY

CPT 61682: Craniotomy for Resection of Complex Supratentorial AVM

CPT-61697-INTRACRANIAL-ANEURYSM-REPAIR-INTERNAL-CAROTID

CPT 61697: Intracranial Aneurysm Repair, Internal Carotid Circulation

CPT-61703-INTRACRANIAL-ANEURYSM-CLIPPING-WITH-CAROTID-CONTROL

CPT 61703: Intracranial Aneurysm Clipping with Carotid Control

CPT-61684-INFRATENTORIAL-AVM-RESECTION-SMALL-ACCESSIBLE

CPT 61684: Resection of Small Infratentorial Arteriovenous Malformation

Showing 1–10 of 14

Taxonomy Code	Specialty	Notes
2084N0400X	Neurological Surgery	Primary specialty performing intracranial AVM resections.
208D00000X	Vascular Surgery	May assist for complex vascular reconstruction or bypass techniques.
207VG0300X	Critical Care Medicine	Provides perioperative ICU management for complex neurosurgical patients.
208000000X	Neurology	Involved preoperatively for diagnostic evaluation and postoperative neurologic care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I60.8`	Other nontraumatic subarachnoid hemorrhage	AVM rupture with subarachnoid hemorrhage is a common presentation prompting surgical AVM resection.
`I67.1`	Cerebral aneurysm, nonruptured (note: often used with vascular malformations)	Vascular pathology that may coexist or be part of preoperative differential; sometimes coded with AVM management.
`I67.4`	Other cerebrovascular malformations	Directly describes arteriovenous malformations and related lesions necessitating resection.
`I69.398`	Sequelae of other cerebrovascular disease, other residuals of cerebrovascular disease	Used for chronic neurologic deficits resulting from prior AVM hemorrhage or ischemia in long-term follow-up.
`G93.49`	Other disorders of brain in diseases classified elsewhere (e.g., intracranial vascular lesion with mass effect)	Used when AVM causes mass effect or other brain dysfunction requiring surgical intervention.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61686`	Craniectomy or craniotomy for excision of intracranial vascular malformation (AVM), infratentorial, complex (>3 cm or deep venous drainage or eloquent cortex involvement)	Primary operative code for resection of a complex infratentorial AVM.
`61312`	Craniectomy or craniotomy, posterior fossa; for tumor, abscess, or other lesion (not AVM specific)	May describe posterior fossa exposure technique; used when operative documentation centers on exposure rather than AVM-specific resection in atypical billing scenarios.
`61680`	Craniectomy or craniotomy for excision of intracranial vascular malformation, supratentorial, complex	Related code for similar AVM resections in a different anatomic compartment; used for coding comparison and when multiple AVMs in both compartments are addressed in staged care.
`61618`	Stereotactic radiosurgery, when pre- or post-resection radiosurgical treatment to AVM nidus is performed	Used when radiosurgery is part of the multimodal treatment plan (often billed separately by radiosurgery provider).
`99152`	Moderate sedation services provided by the same physician performing a procedure (initial 15 minutes)	Occasionally applicable for monitored anesthesia care components if documented and billable by provider (use per payer rules).

OpenPayer