61210

Burr Hole(s); for implanting ventricular catheter, reservoir, EEG electrodes, pressure recording device, or other intracerebral device

CPT code 61210 refers to a neurosurgical procedure where the surgeon creates one or more burr holes—small openings in the skull—to facilitate the implantation of various intracerebral devices. This procedure is a foundational technique in neurosurgery used when direct access to the brain's internal structures or the ventricular system is required for therapeutic or diagnostic purposes without the necessity of a full craniotomy. The surgeon typically identifies the optimal site for the burr hole based on anatomical landmarks, such as Kocher’s point for ventricular access, or via image-guided neuronavigation. Once the patient is prepped and positioned, a localized scalp incision is made, and the periosteum is reflected to expose the bone. A specialized surgical drill, such as a hand-held Hudson brace or a high-speed pneumatic drill, is used to penetrate the cranium. After the bone flap (or bone dust) is managed, the dura mater is exposed and subsequently incised to allow the passage of the device. This code specifically covers the implantation of devices such as external ventricular drains (EVDs) for managing intracranial pressure, Ommaya reservoirs for long-term cerebrospinal fluid (CSF) sampling or chemotherapy administration, intracranial pressure (ICP) monitors, or depth electrodes for electroencephalographic (EEG) monitoring in epilepsy patients. The procedure concludes with the securing of the device to the skull or scalp to prevent migration and the closure of the soft tissue layers. CPT 61210 captures the technical effort of both the bone work and the device placement within the intracerebral space.

Clinical Indications

  • Acute hydrocephalus requiring external ventricular drainage
  • Monitoring of intracranial pressure (ICP) in patients with traumatic brain injury
  • Placement of an Ommaya reservoir for intrathecal chemotherapy delivery
  • Surgical evaluation of epilepsy via depth electrode implantation
  • Management of symptomatic brain cysts or abscesses via catheter drainage
  • Normalization of cerebrospinal fluid pressure in cases of subarachnoid or intracerebral hemorrhage
  • Monitoring for intracranial hypertension in patients with hepatic encephalopathy or severe meningitis

Procedure Steps

  1. Position the patient in a supine or semi-fowler position with the head secured in a headrest or pins.
  2. Perform scalp marking and local anesthesia infiltration at the planned incision site.
  3. Make a linear or curvilinear incision through the scalp and galea down to the pericranium.
  4. Retract the scalp edges and clear the pericranium to expose the outer table of the skull.
  5. Create a burr hole using a surgical drill, ensuring the drill bit stops upon reaching the inner table/dura.
  6. Irrigate the hole to remove bone debris and achieve hemostasis of the bone edges.
  7. Coagulate and incise the dura mater to expose the underlying arachnoid or cortical surface.
  8. Pass the ventricular catheter, electrode, or pressure probe through the dural opening into the brain tissue or ventricle.
  9. Confirm device placement via CSF flow (for catheters) or monitoring equipment signals.
  10. Secure the device to the skull using sutures or specialized anchors.
  11. Tunnel the distal end of the catheter if a reservoir or external drain is being used.
  12. Close the galea and skin in layers with absorbable and non-absorbable sutures.

Coding Guidelines

  • CPT 61210 includes the creation of the burr hole(s) and the initial implantation of the device; do not report a separate burr hole code (e.g., 61107) for the same access.
  • If the procedure is performed bilaterally, append modifier 50 to the code, unless the code description specifically specifies 'burr holes' (plural) in a way that includes bilateral work (though 61210 is generally reported once for the encounter unless distinct sites are addressed).
  • For the replacement or revision of a previously implanted ventricular catheter, see codes 62225 or 62230.
  • If image guidance (e.g., stereotactic navigation) is used, code 61781 or 61782 may be reported as an add-on code if the documentation supports it.
  • Do not report 61210 in conjunction with major craniotomy codes for the same intracranial site.
  • For the removal of these devices, see specific removal codes or E/M codes depending on the complexity and site of the removal.

Associated ICD-10 Codes