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An infratentorial craniectomy or craniotomy is a surgical procedure performed to evacuate a hematoma located in the infratentorial region of the brain, which is situated below the tentorium cerebelli. The tentorium cerebelli is a fold of dura mater that separates the cerebellum from the cerebrum, specifically the frontal and occipital lobes. This procedure addresses two types of hematomas: extradural and subdural. An extradural hematoma occurs when there is a collection of blood between the inner table of the skull and the dural membrane, often resulting from trauma. In contrast, a subdural hematoma is characterized by blood accumulation between the dural and arachnoid membranes, typically due to the tearing of veins during head injury. The surgical approach involves creating scalp flaps and making burr holes in the skull. The bone between these burr holes is then cut, allowing for the elevation of a bone flap, which may be temporarily or permanently removed. In the case of a craniotomy, the scalp is incised, and both scalp and bone flaps are raised to access the hematoma. If a subdural hematoma is present, the dural flaps are also elevated. The hematoma is evacuated using specialized instruments such as biopsy forceps, gentle suction, and irrigation techniques. After the evacuation, the dural flap is carefully repositioned over the brain and secured with sutures to prevent cerebrospinal fluid leakage. A temporary drain may be placed if residual fluid is present. Finally, the bone flap is reattached and secured, and the scalp is closed in layers. This procedure is critical for alleviating pressure on the brain and preventing further complications associated with hematomas.
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The infratentorial craniectomy or craniotomy for evacuation of hematoma is indicated for the following conditions:
The procedure begins with the creation of scalp flaps, which involves making incisions in the scalp to allow for access to the underlying skull. Following this, several burr holes are drilled into the skull to facilitate the removal of the bone. The bone between these burr holes is then carefully cut using a saw or craniotome, allowing for the elevation of a bone flap. This flap may be temporarily or permanently removed, depending on the specific circumstances of the surgery. In the case of a craniotomy, the scalp is incised, and both the scalp and bone flaps are raised to expose the extradural hematoma. If a subdural hematoma is present, dural flaps are also raised to gain access to the hematoma. Once the hematoma is accessible, the surgeon employs biopsy forceps, gentle suction, and irrigation techniques to remove the collection of blood effectively. After the evacuation of the hematoma is complete, the dural flap is repositioned over the exposed brain and secured with sutures, ensuring a tight closure to prevent any leakage of cerebrospinal fluid. In some cases, a temporary drain may be placed in the subdural space to facilitate the drainage of any residual fluid. The bone flap is then reattached over the dura and anchored using steel sutures. Alternatively, if a craniectomy defect is present, it may be plugged with bone wax or silicone to ensure stability. Finally, the fascia and muscle layers are closed, followed by the layered closure of the scalp to complete the procedure.
Post-procedure care involves monitoring the patient for any signs of complications, such as infection or cerebrospinal fluid leakage. Patients may require imaging studies to assess the surgical site and ensure that the hematoma has been adequately evacuated. Recovery may vary depending on the extent of the surgery and the patient's overall health. It is essential to follow up with the healthcare team for any necessary rehabilitation or further treatment, as well as to manage pain and other symptoms that may arise during the recovery process.
| Short Descr | CRNEC/CRNOT ITTL XDRL/SDRL | Medium Descr | CRNEC/CRNOT HMTMA INFRATENTORIAL XDRL/SDRL | Long Descr | Craniectomy or craniotomy for evacuation of hematoma, infratentorial; extradural or subdural | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 2 | CCS Clinical Classification | 1 - Incision and excision of CNS |
This is a primary code that can be used with these additional add-on codes.
| 69990 | Addon Code MPFS Status: Restricted APC N ASC N1 PUB 100 CPT Assistant Article 1Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2025-01-01 | Changed | Short and Medium Descriptions changed. |
| 2011-01-01 | Changed | Medium description changed. |
| Pre-1990 | Added | Code added. |
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