0289 Grid Monitoring and Intraoperative Electroencephalography...Oct 16, 2019 · received general anesthesia with planned intensive care unit (ICU) admission were included. Duration

Grid Monitoring and Intraoperative Electroencephalography - Medical Clinical Policy Bu... Page 1 of 25

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Grid Monitoring and Intraoperative Electroencephalography

Policy History

Last Review

05/06/2021

Effective: 10/13/1998

Next

Review: 03/10/2022

Review History

Definitions

Additional Information

Clinical Policy Bulletin

Notes

Number: 0289

Policy *Please see amendment for Pennsylvania Medicaid at the end of this CPB.

I. Intraoperative Electroencephalography (EEG)

Aetna considers intraoperative scalp EEG medically

necessary for the following indications:

A. Monitoring cerebral function during carotid artery

surgery; or

B. Monitoring cerebral function during intracranial

vascular surgical procedures; or

C. Monitoring cerebral function during parietal tumor

resection or resection of lesion near the eloquent

cortex.

Aetna considers intraoperative EEG experimental and

investigational for open-heart surgery and for all other

indications (e.g., prediction of post-operative delirium)

because its clinical value has not been established.

https://aetnet.aetna.com/mpa/cpb/200_299/0289.html

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Note: The use of intraoperative EEG to monitor brain

function for anesthetic drug administration in order to

determine depth of anesthesia is considered integral to

the anesthesia and not separately reimbursed. In

addition, this use of intraoperative EEG is considered

experimental and investigational.

II. Grid Monitoring (Electrocorticography, ECoG)

Aetna considers grid monitoring to determine the

location of the epileptogenic focus for possible surgical

resection medically necessary for members with

intractable seizures when any of the following

conditions is met:

A. Seizures arise from functionally important brain

areas; or

B. Surface (scalp) electroencephalogrphy (EEG)

recording did not adequately localize the

epileptogenic area, or

C. There is a discordance between electrophysiological

localization and that provided by other

neurodiagnostic studies suggesting an abnormality

in more than one region of the brain.

Aetna considers grid monitoring experimental and

investigational for all other indications because its clinical

value for these indications has not been established.

Notes: Grid monitoring is considered appropriate only when

used by centers that have expertise and experience,

especially with younger persons.

See also CPB 0322 - Electroencephalography (EEG) Video

Monitoring (../300_399/0322.html), CPB 0394 - Epilepsy

Surgery (../300_399/0394.html), CPB 0425 - Ambulatory

Electroencephalography (../400_499/0425.html).




Background

Standard scalp electroencephalography measures and

records the electrical activity of the brain by placing electrodes

on the scalp/head; most commonly used when a physician is

trying to establish the presence of a seizure disorder.

For patients with intractable seizures, the best surgical

outcome is attained after precise localization of the seizure

focus. Scalp electroencephalography (EEG) monitoring may

be insufficient and invasive subdural EEG monitoring (by

means of subdural grid electrodes) has been used. Subdural

electrodes provide coverage of large areas of neocortex and

are ideally suited for evaluating children with intractable

epilepsy and to functionally map critical cortex.

Multi-contact depth electrodes may be implanted into the brain

to record electrical activity from deep or superficial cortical

structure. Strips or rectangular grid arrays (subdural

electrodes) can be placed under the dura to record activity in

this region.

Subdural grid electrodes can be used for recording as well as

for stimulating neural tissue to identify the underlying function

(e.g., language areas, sensation or motor function). These

electrodes remain in place for several days to up to 1 to 2

weeks, as needed to record seizures and map brain. They are

then removed and epilepsy surgery performed, if findings are

favorable for such surgery. In some patients in whom invasive

monitoring fails to locate the seizure focus, re-investigation

with invasive subdural electrodes can identify the origin of

seizure and allow successful surgical treatment.

Invasive EEG monitoring with subdural grid electrodes is

associated with significant complications; however, most of

them are transient. Higher complication rates are related to an




increased number of electrode contacts, increased length of

the monitoring period, placement of burr holes in addition to

the craniotomy, and multiple cable exit sites.

An American Academy of Neurology Technology Assessment

(Nuwer, et al., 1990) stated that electrocorticography (ECog)

from surgically exposed cortex can help to define the optimal

limits of a surgical resection, identifying regions of greatest

impairment. Regions of attenuated or absent EEG, or those

with relatively increased slow activity, decrease in fast activity,

or abnormal spike discharges help to define regions of cortex

that are impaired or abnormal. When used together with long-

term EEG/video monitoring, ECoG can help to define the limits

of resection for surgery for epilepsy.

An American Academy of Neurology Technology Assessment

(Nuwer, et al., 1990) stated that intraoperative scalp EEG

monitoring has long been carried out in an effort to safeguard

the brain during carotid endarterectomy. The assessment

stated that this technique has been shown to be safe and

efficacious for such use and for other similar situations in

which cerebral blood flow is at high risk. For this purpose,

monitoring should be carried out at least at the anterior and

posterior regions over each hemisphere. The AAN technology

assessment stated that sixteen channels are preferable to

identify occasional embolic complications.

A Medicare National Coverage Determination (CMS, 2006) on

EEG monitoring during surgical procedures involving the

cerebral vasculature states that EEG monitoring may be

covered routinely in carotid endarterectomies and in other

neurological procedures where cerebral perfusion could be

reduced. Such other procedures might include aneurysm

surgery where hypotensive anesthesia is used or

other cerebral vascular procedures where cerebral blood flow

may be interrupted. A Medicare National Coverage

Determination on EEG monitoring for open-heart surgery

stated that the value of EEG monitoring during open heart




surgery and in the immediate post-operative period is

debatable because there are little published data based on

well designed studies regarding its clinical effectiveness. The

NCD states that the procedure is not frequently used for this

indication and does not enjoy widespread acceptance of

benefit.

One or two channel intraoperative EEG analysis modules have

been used by anesthesiologists to gauge depth of anesthesia,

such as the Bi-Spectral device (BIS). Such use of limited

channel intraoperative EEG for monitoring depth of anesthesia

(and level of consciousness) is considered integral to the

anesthesia service and not separately reimbursable. In

addition, a one or two channel EEG device does not meet the

minimal technical requirements for EEG testing as set forth by

the American Clinical Neurophysiology Society.

Prediction of Post-Operative Delirium

Fritz and colleagues (2016) stated that post-operative delirium

is a common complication associated with increased morbidity

and mortality, longer hospital stays, and greater health care

expenditures. Intra-operative EEG slowing has been

associated previously with post-operative delirium, but the

relationship between intra-operative EEG suppression and

post-operative delirium has not been investigated. In this

observational cohort study, a total of 727 adult patients who

received general anesthesia with planned intensive care unit

(ICU) admission were included. Duration of intra-operative

EEG suppression was recorded from a frontal EEG channel

(FP1 to F7). Delirium was assessed twice-daily on post-

operative days 1 through 5 with the Confusion Assessment

Method for the ICU. Thirty days after surgery, quality of life

(QOL), functional independence, and cognitive ability were

measured using the Veterans RAND 12-item survey, the

Barthel index, and the PROMIS Applied Cognition-Abilities-

Short Form 4a survey. Post-operative delirium was observed

in 162 (26 %) of 619 patients assessed. When these




researchers compared patients with no EEG suppression with

those divided into quartiles based on duration of EEG

suppression, patients with more suppression were more likely

to experience delirium (χ(4) = 25, p < 0.0001). This effect

remained significant after these investigators adjusted for

potential confounders (odds ratio [OR] for log(EEG

suppression) 1.22 (99 % confidence interval [CI]:, 1.06 to 1.40,

p = 0.0002] per 1-minute increase in suppression); EEG

suppression may have been associated with reduced

functional independence (Spearman partial correlation

coefficient -0.15, p = 0.02); but not with changes in QOL or

cognitive ability. Predictors of EEG suppression included

greater end-tidal volatile anesthetic concentration and lower

intra-operative opioid dose. The authors concluded that EEG

suppression is an independent risk factor for post-operative

delirium. Moreover, they stated that future studies should

examine if anesthesia titration to minimize EEG suppression

decreases the incidence of post-operative delirium.

This study has several major drawbacks: (i) because this was

an observational study, the findings cannot indicate

whether the relationship between EEG suppression and

delirium is causal. Delirium was assessed as part of routine

clinical care, and such assessments have limited sensitivity

despite high specificity, (ii) some patients either left the ICU

prior to the first delirium assessment or were sedated at all

assessment time points, (iii) the post-discharge outcomes

may be limited due to incomplete survey responses,

particularly because patients who experienced post-

operative delirium were less likely to return the survey, (iv)

the Barthel Index was not performed pre-operatively, and

thus it was not possible to distinguish whether patients

who experienced EEG suppression had reduced functional

independence before surgery as well, and (v) this study also

restricted its focus to patients with planned ICU admission

after surgery, so care should be taken when applying these

results to a broader surgical patient population. This




research group is currently conducting the ENGAGES clinical

trial (NCT02241655), which may shed further light on the

association between intra-operative burst suppression and

post-operative delirium.

Prediction of Emergence Agitation After Sevoflurane Anesthesia

Jang and colleagues (2018) noted that emergence agitation

(EA) is common after sevoflurane anesthesia, but there are no

definite predictors. In a prospective, predictive study, these

researchers examined if intra-operative EEG can indicate the

occurrence of EA in children. EEG-derived parameters

(spectral edge frequency 95, beta, alpha, theta, and delta

power) were measured at 1.0 minimum alveolar concentration

(MAC) and 0.3 MAC of end-tidal sevoflurane (EtSEVO) in 29

patients. EA was evaluated using an EA score (EAS) in the

post-anesthetic care unit on arrival (EAS 0) and at 15 and 30

minutes after arrival (EAS 15 and EAS 30). The correlation

between EEG-derived parameters and EAS was analyzed

using Spearman correlation, and receiver-operating

characteristic curve analysis was used to measure the

predictability. EA occurred in 11 patients. The alpha power at

1.0 MAC of EtSEVO was correlated with EAS 15 and EAS 30.

The theta/alpha ratio at 0.3 MAC of EtSEVO was correlated

with EAS 30. The area under the receiver-operating

characteristic curve of percentage of alpha bands at 0.3 MAC

of EtSEVO and the occurrence of EA was 0.672. The authors

concluded that children showing high-alpha powers and low

theta powers (= low theta/alpha ratio) during emergence from

sevoflurane anesthesia were at high risk of EA in the post-

anesthetic care unit. These preliminary findings need to be

validated by well-designed studies.

Intraoperative Electroencephalography During Parietal Tumor Resection




Mueller et al (1996) examined the usefulness of functional

magnetic resonance imaging (fMRI) to map cerebral functions

in patients with frontal or parietal tumors. Charts and images

of patients with cerebral tumors or vascular malformations who

underwent fMRI with an echoplanar technique were reviewed.

The fMRI maps of motor (11 patients), tactile sensory (12

patients), and language tasks (4 patients) were obtained. The

location of the fMRI activation and the positive responses to

intra-operative cortical stimulation were compared. The

reliability of the paradigms for mapping the rolandic cortex was

evaluated. Rolandic cortex was activated by tactile tasks in all

12 patients and by motor tasks in 10 of 11 patients. Language

tasks elicited activation in each of the 4 patients. Activation

was obtained within edematous brain and adjacent to tumors.

fMRI in 3 cases with intra-operative electrocortical mapping

results showed activation for a language, tactile, or motor task

within the same gyrus in which stimulation elicited a related

motor, sensory, or language function. In patients with greater

than 2 cm between the margin of the tumor, as revealed by

MRI, and the activation, no decline in motor function occurred

from surgical resection. The authors concluded that fMRI of

tactile, motor, and language tasks was feasible in patients with

cerebral tumors; fMRI showed promise as a means of

determining the risk of a post-operative motor deficit from

surgical resection of frontal or parietal tumors.

Karatas et al (2004) noted that cases with intractable epilepsy

may present with multiple lesions in their brains. Ictal-

electroencephalography (EEG) carries a great value in

identification of the primary epileptogenic source. On the other

hand, removal of low-grade tumors located around the

eloquent cortex may be risky with conventional techniques.

Functional-neuronavigation (f-NN) is the integration of fMRI

and stereotactic technologies; and provides interactive data

regarding localization of the motor cortex. This report

presented a case with dysembryoplastic neuro-epithelial tumor

(DNET), which was removed using f-NN and

electrocorticography (ECoG) techniques. A 19-year old




patient with intractable complex partial and secondary

generalized seizures was presented; MRI revealed a low-

grade tumor located in right parietal region just behind the

motor cortex, and a contralateral temporal arachnoid cyst.

Ictal-EEG demonstrated the right parietal origin of the

seizures. The patient underwent a right parietal craniotomy

and tumor excision using f-NN and ECoG techniques

intraoperatively. ECoG findings correlated with

epileptogenicity of the parietal lesion. Post-operative course

was uneventful; no post-operative deficit was observed. The

patient was seizure-free in 8 months follow-up. Pathological

examination reported the lesion as DNET. The authors

concluded that ictal-EEG had a very important role in

identification of the epileptogenic focus in cases with multiple

brain lesions. Preservation of the functional cortex was the

most prominent aim during lesional surgery of epilepsy. Intra-

operative mapping using f-NN and ECoG supported the

orientation of the neurosurgeon to the functional and

epileptogenic cortical areas; and thus, increased the safety

and efficacy of surgical procedures.

Maesawa et al (2016) stated that few studies have examined

the clinical characteristics of patients with lesions in the deep

parietal operculum facing the sylvian fissure, the region

recognized as the secondary somatosensory area (SII).

Moreover, surgical approaches in this region are challenging.

These investigators reported on a patient presenting with SII

epilepsy with a tumor in the left deep parietal operculum. The

patient was a 24-year old man who suffered daily partial

seizures with extremely uncomfortable dysesthesia and/or

occasional pain on his right side. MRI revealed a tumor in the

medial aspect of the anterior transverse parietal gyrus,

surrounding the posterior insular point. Long-term video-EEG

monitoring with scalp electrodes (for determination of

epileptogenesis) failed to show relevant changes to seizures.

Resection with cortical and subcortical mapping under awake

conditions was performed. A negative response to stimulation

was observed at the subcentral gyrus during language and



Grid Monitoring and Intraoperative Electroencephalography - Medical Clinical Policy ... Page 10 of 25

somatosensory tasks; thus, the transcortical approach

(specifically, a trans-subcentral gyral approach) was used

through this region. Subcortical stimulation at the medial

aspect of the anterior parietal gyrus and the posterior insula

around the posterior insular point elicited strong dysesthesia

and pain in his right side, similar to manifestation of his

seizure. The tumor was completely removed and

pathologically diagnosed as pleomorphic xantho-astrocytoma.

His epilepsy disappeared without neurological deterioration

post-operatively. In this case study, 3 points were clinically

significant. First, the clinical manifestation of this case was

quite rare, although still representative of SII epilepsy.

Second, the location of the lesion made surgical removal

challenging, and the trans-subcentral gyral approach was

useful when intra-operative mapping was performed during

awake surgery. Third, intra-operative mapping demonstrated

that the patient experienced pain with electrical stimulation

around the posterior insular point. Thus, this report

demonstrated the safe and effective use of the trans-

subcentral gyral approach during awake surgery to resect

deep parietal opercular lesions, clarified electrophysiological

characteristics in the SII area, and achieved successful tumor

resection with good control of epilepsy.

Yao et al (2018) noted that using intra-operative ECoG to

identify epileptogenic areas and improve post-operative

seizure control in patients with low-grade gliomas (LGGs)

remains inconclusive. These researchers retrospectively

reported on a surgery strategy that was based on intra-

operative ECoG monitoring. A total of 108 patients with LGGs

presenting at the onset of refractory seizures were included.

Patients were divided into 2 groups. In Group I, all patients

underwent gross-total resection (GTR) combined with

resection of epilepsy areas guided by intra-operative ECoG,

while patients in Group II underwent only GTR. Tumor

location, tumor side, tumor size, seizure-onset features,

seizure frequency, seizure duration, pre-operative anti-

epileptic drug therapy, intra-operative electrophysiological




monitoring, post-operative Engel class, and histological tumor

type were compared between the 2 groups. Univariate

analysis demonstrated that tumor location and intra-operative

ECoG monitoring correlated with seizure control. There were

30 temporal lobe tumors, 22 frontal lobe tumors, and 2 parietal

lobe tumors in Group I, with 18, 24, and 12 tumors in those

same lobes, respectively, in Group II (p < 0.05). In Group I,

74.07 % of patients were completely seizure-free (Engel Class

I), while 38.89 % in Group II (p < 0.05). In Group I, 96.30 % of

the patients achieved satisfactory post-operative seizure

control (Engel Class I or II), compared with 77.78 % in Group II

(p < 0.05). Intra-operative ECoG monitoring indicated that in

patients with temporal lobe tumors, most of the epileptic

discharges (86.7 %) were d etected at the anterior part of the

temporal lobe. In these patients with epilepsy discharges

located at the anterior part of the temporal lobe, satisfactory

post-operative seizure control (93.3 %) was achieved after

resection of the tumor and the anterior part of the temporal

lobe. The authors concluded that intra-operative ECoG

monitoring provided the exact location of epileptogenic areas

and significantly improved post-operative seizure control of

LGGs. In patients with temporal lobe LGGs, resection of the

anterior temporal lobe with epileptic discharges was sufficient

to control seizures.

Maesawa et al (2018) stated that epilepsy surgery aims to

control epilepsy by resecting the epileptogenic region while

preserving function. In some patients with epileptogenic foci in

and around functionally eloquent areas, awake surgery is

implemented. These investigators analyzed the surgical

outcomes of such patients and discussed the clinical

application of awake surgery for epilepsy. They examined a

total of 5 consecutive patients, in whom these researchers

performed lesionectomy for epilepsy with awake craniotomy,

with post-operative follow-up of greater than 2 years. All

patients showed clear lesions on MRI in the right frontal (n =

1), left temporal (n = 1), and left parietal lobe (n = 3). Intra-

operatively, under awake conditions, sensorimotor mapping




was performed; primary motor and/or sensory areas were

successfully identified in 4 cases, but not in 1 case of temporal

craniotomy. Language mapping was performed in 4 cases,

and language areas were identified in 3 cases. In 1 case with

a left parietal arterio-venous malformation (AVM) scar,

language centers were not identified, probably because of a

functional shift. Electrocorticograms (ECoGs) were recorded

in all cases, before and after resection; ECoG information

changed surgical strategy during surgery in 2 of 5 cases.

Post-operatively, no patient demonstrated neurological

deterioration. Seizure disappeared in 4 of 5 cases (Engel

class 1), but recurred after 2 years in the remaining patient

due to tumor recurrence. Therefore, for patients with

epileptogenic foci in and around functionally eloquent areas,

awake surgery allowed maximal resection of the foci; intra-

operative ECoG evaluation and functional mapping allowed

functional preservation. This led to improved seizure control

and functional outcomes.

CPT Codes / HCPCS Codes / ICD-10 Codes

Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":

Code Code Description

Intra-operative electroencephalographic (EEG) monitoring of cerebral function during intracranial vascular surgical procedures:

CPT codes covered if selection criteria are met:

95812 Electroencephalogram (EEG) extended

monitoring; 41-60 minutes

95813 greater than 1 hour

95822 Electroencephalogram (EEG); recording in

coma or sleep only)



95940 Continuous intraoperative neurophysiology

monitoring in the operating room, one on one

monitoring requiring personal attendance, each

15 minutes (List separately in addition to code

for primary procedure)

95941 Continuous intraoperative neurophysiology

monitoring, from outside the operating room

(remote or nearby) or for monitoring of more

than one case while in the operation room, per

hour (List separately in addition to code for

primary procedure)

Other CPT codes related to the CPB:







31200 -

31230,

61000 -

61253,

61304 -

61576,

61590 -

61619,

61623 -

61645,

61680 -

61711,

61720 -

61791,

61850 -

61888,

62000 -

62148,

62160 -

62165,

64716,

67570,

69501

69530,

69601 -

69605,

69635 -

69646,

69666 -

69667,

69720 -

69745,

69805 -

69806,

69910 -

69915,

Intracranial vascular surgical procedures



69950 -

69955

HCPCS codes covered if selection criteria are met:

G0453 Continuous intraoperative neurophysiology

monitoring, from outside the operating room

(remote or nearby), per patient, (attention

directed exclusively to one patient) each 15

minutes (list in addition to primary procedure)

ICD-10 codes covered if selection criteria are met:

C71.3 Malignant neoplasm of parietal lobe [parietal

tumor]

C79.31 Secondary malignant neoplasm of brain

[parietal tumor]

D33.0 Benign neoplasm of brain, supratentorial

[parietal tumor]

D43.0 Neoplasm of uncertain behavior of brain,

supratentorial [parietal tumor]

D49.6 Neoplasm of unspecified behavior of brain

[parietal tumor]

G93.89 Other specified disorders of brain [lesion near

the eloquent cortex]

Intra-operative electroencephalographic (EEG) monitoring of cerebral function during carotid artery surgery:


95955 Electroencephalogram (EEG) during non-

intracranial surery (eg, carotid)

Other CPT codes related to this CPB:

5/26/2021https://aetnet.aetna.com/mpa/cpb/200_299/0289.html






37236 -

37237,

37242,

33510,

33889,

33891,

34001,

34151,

35001 -

35002,

35121 -

35122,

35301,

35341,

35390,

35501,

35506,

35508 -

35512,

35515 -

35516,

35518,

35521 -

35523,

35525 -

35526,

35531,

35601,

35606,

35642,

35691,

35694 -

35695,

35701,

36100,

36221 -

Carotid artery surgery



36224,

36227

-36228,

36595,

37215 -

37218,

37600,

37605

-37606,

60600,

60605,

61590 -

61592,

61596,

61611,

61710

ICD-10 codes not covered for indications listed in the CPB :

F05 Delirium due to known physiological condition

[post-operative delirium]

Grid Monitoring (Electrocorticography, ECoG) :


95829 Electrocorticogram at surgery (separate

procedure)

Other CPT codes related to this CPB:

61531 Subdural implantation of strip electrodes

through one or more burr or trephine hole(s) for

long term seizure monitoring

61533 Craniotomy with elevation of bone flap; for

subdural implantation of an electrode array, for

long-term seizure monitoring





61535 for removal of epidural or subdural electrode

array, without excision of cerebral tissue

(separate procedure)

61760 Stereotactic implantation of depth electrodes

into the cerebrum for long term seizure

monitoring

95812 -

95830

Electroencephalography (EEG)

95954 -

95967

Special EEG Tests

95961 Functional cortical and subcortical mapping by

stimulation and/or recording of electrodes on

brain surface, or of depth electrodes, to

provoke seizures or identify vital brain

structures; initial hour of attendance by a

physician or other qualified health care

professional

+95962 each additional hour of attendance by a

physician or other qualified health care

professional (List separately in addition to code

for primary procedure)

Other HCPCS codes related to the CPB:

S8040 Topographic brain mapping

ICD-10 codes covered if selection criteria are met:

G40.00 -

G40.919

Epilepsy and recurrent seizures

R56.1 Post traumatic seizures

R56.9 Unspecified convulsions




The above policy is based on the following references:



1. Adelson PD, Black PM, Madsen JR, et al. Use of grids

and strip electrodes to identify a seizure locus in

children. Pediatr Neurosurg. 1995;22(4):174-180.

2. American Academy of Neurology (AAN).

Electroencephalography (EEG) —routine (95812-

95827). Coding FAQs. Rochester, MN: AAN; 2011.

Available at:

http://www.aan.com/go/practice/coding/faqs.

Accessed August 17, 2011.

3. Ballotta E, Dagiau G, Saladini M, et al. Results of

electroencephalographic monitoring during 369

consecutive carotid artery revascularizations. Eur

Neurol. 1997;37(1):43-47.

4. Brewster DC, O'Hara PJ, Darling RC, Hallett JW Jr.

Relationship of intraoperative EEG monitoring and

stump pressure measurements during carotid

endarterectomy. Circulation. 1980;62(2 Pt 2):I4-I7.

5. Burkholder DB, Sulc V, Hoffman EM, et al. Interictal

scalp electroencephalography and intraoperative

electrocorticography in magnetic resonance imaging-

negative temporal lobe epilepsy surgery. JAMA Neurol.

2014;71(6):702-709.

6. Byer JA, Henzel JH, Dexter JD. Correlation of

intraoperative electroencephalography with

neurologic deficit after carotid endarterectomy. South

Med J. 1979;72(8):956-958.

7. Centers for Medicare and Medicaid Services (CMS).

Electroencephalographic monitoring during surgical

procedures involving the cerebral vasculature.

National Coverage Determination. Medicare Coverage

Issues Manual Section 35-37. CMS Manual Section

160.8, Publication No. 100-3. Baltimore, MD: CMS;

effective June 19, 2006.

8. Centers for Medicare and Medicaid Services (CMS).

Electroencephalographic (EEG) monitoring during


http://www.aan.com/go/practice/coding/faqs

https://aetnet.aetna.com/mpa/cpb/200_299/0289.html 5/26/2021


open-heart surgery. National Coverage Determination.

CMS Manual Section 160.9, Publication No. 100-3.

Baltimore, MD: CMS; 2010.

9. Cho I, Smullens SN, Streletz LJ, Fariello RG. The value of

intraoperative EEG monitoring during carotid

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10. Fiol ME, Gates JR, Mireles R, et al. Value of

intraoperative EEG changes during corpus callosotomy

in predicting surgical results. Epilepsia. 1993;34(1):74-

78.

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complications: A 20-year experience. Stereotact Funct

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Intraoperative electroencephalogram suppression

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intraoperative EEG to predict the occurrence of

emergence agitation in the postanesthetic room after

sevoflurane anesthesia in children. J Perianesth Nurs.

2018;33(1):45-52.

15. Johnston JM Jr, Mangano FT, Ojemann JG, et al.

Complications of invasive subdural electrode

monitoring at St. Louis Children's Hospital, 1994-2005.

J Neurosurg. 2006;105(5 Suppl):343-347.

16. Jones TH, Chiappa KH, Young RR, et al. EEG monitoring

for induced hypotension for surgery of intracranial

aneurysms. Stroke. 1979;10(3):292-294.

17. Karatas A, Erdem A, Savas A, et al. Identification and

removal of an epileptogenic lesion using Ictal-EEG,

functional-neuronavigation and electrocorticography. J

Clin Neurosci. 2004;11(3):343-346.




18. Kutsy RL, Farrell DF, Ojemann GA. Ictal patterns of

neocortical seizures monitored with intracranial

electrodes: Correlation with surgical outcome.

Epilepsia. 1999;40(3):257-266.

19. Lagerlund TD, Cascino GD, Cicora KM, Sharbrough FW.

Long-term electroencephalographic monitoring for

diagnosis and management of seizures. Mayo Clin

Proc. 1996;71(10):1000-1006.

20. Liubinas SV, Cassidy D, Roten A, et al. Tailored cortical

resection following image guided subdural grid

implantation for medically refractory epilepsy. J Clin

Neurosci. 2009;16(11):1398-1408.

21. Maesawa S, Fujii M, Futamura M, et al. A case of

secondary somatosensory epilepsy with a left deep

parietal opercular lesion: Successful tumor resection

using a transsubcentral gyral approach during awake

surgery. J Neurosurg. 2016;124(3):791-798.

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AETNA BETTER HEALTH® OF PENNSYLVANIA

Amendment to Aetna Clinical Policy Bulletin Number: 0289 Grid

Monitoring and Intraoperative Electroencephalography

There are no amendments for Medicaid.

revised 05/06/2021

0289 Grid Monitoring and Intraoperative Electroencephalography...Oct 16, 2019 · received general anesthesia with planned intensive care unit (ICU) admission were included. Duration

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