Summary & Overview
CPT 61690: Craniectomy and Resection of Simple Dural Arteriovenous Malformation
CPT code 61690 denotes an open neurosurgical procedure—craniectomy with resection of a simple dural arteriovenous malformation (AVM) measuring 3 cm or less, easily accessible and lacking deep venous drainage or involvement of eloquent cortex. This procedure represents a specific, high-complexity operative intervention important for surgical management of select intracranial vascular lesions. Nationally, accurate coding of 61690 affects claims processing, case mix classification, and monitoring of neurosurgical service utilization.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines clinical context for appropriate use of the code, common billing modifiers, typical sites of service, and payer coverage considerations. Readers will find benchmarks for utilization, coding guidance drawn from the code description, and summaries of payer policy themes where available. The content is intended to help billing managers, clinical coders, and policy analysts understand the clinical scenario represented by 61690, how it maps to surgical service lines, and what elements drive payer adjudication and documentation requirements.
Data not available in the input for some fields (such as detailed payer policy differences, associated taxonomies, and specific ICD-10 diagnosis pairings) is noted where applicable.
Billing Code Overview
CPT code 61690 describes a neurosurgical procedure involving craniectomy (removal of a portion of the skull) and resection of a simple arteriovenous malformation (AVM) located in the dura mater. The procedure is indicated for an AVM that is 3 cm or less, readily accessible, without deep venous drainage, and not involving eloquent cortical areas responsible for functions such as sensation, speech, or language.
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Service type: Neurosurgical open resection of dural arteriovenous malformation
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Typical site of service: Inpatient or outpatient hospital operating room (neurosurgery service), depending on clinical context and facility capabilities
Clinical & Coding Specifications
Clinical Context
A 42-year-old right-handed patient presents with new-onset focal seizures and intermittent headaches. Magnetic resonance imaging (MRI) with and without contrast and cerebral angiography identify a small (≤3 cm) superficially located dural arteriovenous malformation (AVM) over the left parietal convexity without deep venous drainage and not involving eloquent cortex. After multidisciplinary review by neurosurgery and interventional neuroradiology, the patient is scheduled for elective open craniotomy and microsurgical resection of the dural AVM. The clinical workflow includes preoperative assessment (history, neurological exam, CT/MRI, catheter angiography), pre-anesthesia evaluation, informed consent documenting risks (bleeding, infection, neurologic deficit), intraoperative neuronavigation and microsurgical technique with possible intraoperative angiography to confirm complete resection, immediate postoperative neurological monitoring in a neurosurgical ICU or step-down unit, and follow-up imaging (MRI or angiography) to confirm obliteration of the AVM and guide antiepileptic medication management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard claim processing | Use when no additional modifier applies to the billed service |
11 |