0 code page views remaining today. Guest accounts are limited to 2 daily page views. Register free account to get more views.
Log in Register free account

Official Description

Exploration of orbit (transcranial approach), with removal of lesion

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 61333 involves the exploration of the orbit using a transcranial approach, which is a surgical technique that allows access to the orbit through the skull. This approach can be executed by either removing a section of the frontal bone while preserving the orbital rim or by removing both the frontal bone and the supraorbital arch. The primary purpose of this procedure is to gain access to the superomedial aspect of the orbit, particularly for addressing lesions or defects located at the orbital apex, optic canal, or those that involve both the orbit and adjacent intracranial structures. The surgical process begins with a bicoronal incision, which is made across the scalp, allowing for the reflection of the scalp to expose the underlying structures. The procedure requires careful manipulation of the frontal lobe and the dura mater, ensuring that the surrounding tissues are preserved as much as possible. The removal of the lesion is performed with precision, ensuring that a margin of healthy tissue is included to minimize the risk of recurrence. After the lesion is excised, the surgical team reconstructs the orbit and secures the frontal bone back in place, followed by the repair of the soft tissues and skin. This complex procedure necessitates a thorough understanding of cranial anatomy and meticulous surgical technique to ensure optimal outcomes for the patient.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The exploration of the orbit via a transcranial approach, as described by CPT® Code 61333, is indicated for various conditions that necessitate direct access to the orbit and surrounding intracranial structures. The following are specific indications for this procedure:

  • Lesions at the Orbital Apex Lesions located at the apex of the orbit may require surgical intervention to alleviate symptoms or remove pathological tissue.
  • Optic Canal Involvement Conditions affecting the optic canal, which may impact vision or cause other neurological symptoms, can necessitate this surgical approach for effective treatment.
  • Defects Involving Both Orbit and Intracranial Structures Lesions or defects that extend into both the orbit and the intracranial space may require exploration and removal to prevent complications and restore function.

2. Procedure

The procedure for exploration of the orbit using a transcranial approach involves several detailed steps, each critical for successful execution:

  • Bicoronal Incision The procedure begins with the creation of a bicoronal incision across the scalp, which allows for adequate exposure of the frontal bone and underlying structures. The scalp is then carefully reflected to provide access to the surgical site.
  • Placement of Burr Holes Medial and frontal burr holes are drilled above the orbital rims to facilitate the removal of the frontal bone. These burr holes are strategically placed to ensure optimal access to the orbit.
  • Removal of Frontal Bone A bone saw is utilized to connect the burr holes, allowing for the removal of a section of the frontal bone. This step is crucial for gaining access to the frontal fossa and the orbit.
  • Reflection of the Dura The dura mater is carefully reflected away from the floor of the frontal fossa, which is essential for exposing the underlying structures and ensuring that the frontal lobe can be retracted safely.
  • Osteotomy of the Orbital Rim An osteotomy is performed on the orbital rim or frontal bar by drilling inferomedial and inferolateral burr holes, which are then connected using a reciprocating saw. This step is vital for creating a pathway to the orbit.
  • Transverse Osteotomy A burr hole is centered in the anterior floor of the frontal fossa, and a transverse osteotomy is performed to complete the release of the orbital rim, further facilitating access to the lesion.
  • Dissection of the Lesion Once access is achieved, the lesion is located and meticulously dissected free from surrounding tissue, ensuring that a margin of healthy tissue is preserved to minimize the risk of recurrence.
  • Reconstruction of the Orbit After the lesion is excised, the orbital bony structures are replaced, and the orbit is reconstructed to restore its anatomical integrity.
  • Inspection of the Dura The dura mater is inspected for any signs of injury, which is critical for preventing postoperative complications.
  • Replacement of Frontal Bone The removed section of the frontal bone is then replaced and secured in position using miniplates and screws, ensuring stability and proper healing.
  • Repair of Soft Tissues and Skin Finally, the overlying soft tissues and skin are repaired, completing the surgical procedure and preparing the patient for recovery.

3. Post-Procedure

Post-procedure care following the exploration of the orbit via a transcranial approach is essential for ensuring proper recovery and minimizing complications. Patients are typically monitored for any signs of neurological deficits or complications related to the surgery. Pain management is provided as needed, and patients may require imaging studies to assess the surgical site. Follow-up appointments are crucial for evaluating the healing process and ensuring that there are no issues with the reconstructed orbit or surrounding structures. Additionally, patients may be advised on activity restrictions to promote healing and prevent strain on the surgical site.

Short Descr EXPL ORBIT W/REMOVAL LESION
Medium Descr EXPL ORBIT TRANSCRANIAL APPROACH W/RMVL LESION
Long Descr Exploration of orbit (transcranial approach), with removal of lesion
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) 1 - 150% payment adjustment for bilateral procedures applies.
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 1
CCS Clinical Classification 21 - Other extraocular muscle and orbit therapeutic procedures

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)
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).
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.
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)
RT Right side (used to identify procedures performed on the right side of the body)
Date
Action
Notes
2025-01-01 Changed Short Description changed.
2019-01-01 Changed Code description changed.
Pre-1990 Added Code added.
Code
Description
Code
Description
Code
Description
Code
Description
Code
Description