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MP 7.01.34 Electrocorticography

 

Medical Policy    
Section
Surgery
Original Policy Date
3/31/96
Last Review Status/Date
Reviewed by consensus/2:2003
Issue
2:2003
  Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.

 


 

Description

Electrocorticography (ECoG) uses epidural or subdural electrode arrays to record the electroencephalogram (EEG) from the cerebral cortex. ECoG is an invasive procedure; a craniotomy is required for implantation of the electrodes. The purpose of ECoG is to localize a suspected seizure focus in the cerebral cortex in patients who are candidates for surgery.

 


 

Policy

Extraoperative electrocorticography is considered medically necessary on a prior approval basis for the purpose of recording seizures. Prior to undergoing ECoG, the patient must:

  • have debilitating seizures intractable to anticonvulsant medication;
  • have undergone standard testing that does not clearly localize a seizure focus but does indicate strongly the presence of a focus; and
  • the suspected seizure focus must be in an area of the brain that is accessible for surgery.

Extraoperative ECoG is considered investigational for stimulation and recording in order to determine electrical thresholds of neurons as an indicator of seizure focus.

 


 

Policy Guidelines

No applicable information

 


 

Benefit Application

BlueCard/National Account Issues

Intraoperative ECoG is a long-standing technique used to map abnormal brain tissue in the motor and/or sensory cortex prior to resection of the abnormal tissue. As such, intraoperative ECoG is an integral part of the surgical procedure and is not eligible for coverage as a separate procedure.

For the purposes of concurrent review, high frequency of recording sessions or long duration of implantation may indicate that the ECoG is being used for stimulation and recording to determine neuronal thresholds. EEGs that result from such sessions may show stimulation artifacts that would not occur if EEG recording was performed without stimulation. However, such stimulation artifacts can be filtered out in the recording process and, therefore, will not always be evident in the EEG.

 


 

Rationale

A search of the literature was completed through the MEDLINE database for the period of January 1992 through October 1995. The search strategy focused on references containing the following Medical Subject Headings:

– Electrocorticography
 
– Electroencephalography

Research was limited to English-language journals on humans.

See also:

Technology Evaluation and Coverage 1988: p. 212

 

Codes

Number

Description

CPT  61533  Craniotomy with elevation bone flap; for subdural implantation of an electrode array, for long-term monitoring 
  95950, 95951, 95953, 95954  EEG code range 
ICD-9 Procedure  02.93  Implantation of intracranial neurostimulator (includes depth electrodes) 
  89.14  Electroencephalogram 
ICD-9 Diagnosis  345.00–345.91  Epilepsy code range 
  780.3  Convulsions 
HCPCS  A4556  Electrode 
Type of Service  Surgery 
Place of Service  Inpatient 

 


 

Index

Electrocorticography
Electroencephalography

 


 

Policy History

Date Action Reason
03/31/96 Add to Surgery section New policy
04/15/02 Replace policy Policy reviewed by consensus; new review date only
07/17/03 Replace policy Policy no longer scheduled for review