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CPT®
61440

CPT® Code 61440
Deleted

Official Description

Craniotomy for section of tentorium cerebelli (separate procedure)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 61440 refers to a craniotomy specifically performed for the sectioning of the tentorium cerebelli, which is classified as a separate procedure. The tentorium cerebelli is a significant dural fold that acts as a protective barrier over the cerebellum and separates it from the occipital lobes of the brain. This procedure is typically indicated in cases where there is a need to address conditions such as arteriovenous malformations located in the dura mater at the apex of the tentorium or to relieve life-threatening intracranial pressure that may result in brain herniation. The craniotomy involves making a substantial incision at the base of the head, followed by careful dissection and retraction of the muscles to access the skull. A craniotome or Gigli saw is utilized to create a wide opening in the occipital region, ensuring that surrounding structures, particularly the sinuses, are not damaged. The dura mater is then meticulously opened to expose the tentorium cerebelli, allowing for the necessary surgical interventions to be performed. This procedure is critical in managing severe neurological conditions and requires a high level of precision to minimize risks and ensure patient safety.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The craniotomy for section of the tentorium cerebelli is indicated for specific medical conditions that necessitate surgical intervention. These include:

  • Arteriovenous Malformation: This procedure may be performed to eliminate an arteriovenous malformation located in the dura mater at the apex of the tentorium cerebelli, which can lead to significant neurological complications.
  • Intracranial Pressure Relief: The craniotomy may also be indicated to relieve life-threatening intracranial pressure and swelling that can cause the brain to herniate through the tentorium, resulting in brain stem compression.

2. Procedure

The procedure for a craniotomy for section of the tentorium cerebelli involves several critical steps:

  • Incision: A Y-shaped or large midline incision is made at the base of the head, extending to the upper vertebrae. This incision allows access to the underlying structures.
  • Muscle Dissection: The muscles are carefully dissected and retracted to expose the skull, ensuring that surrounding tissues are preserved as much as possible.
  • Craniotomy: A wide craniotomy is performed in the occipital region using a craniotome or Gigli saw. Special care is taken to avoid damaging the sinuses during this step.
  • Dura Mater Exposure: Once the craniotomy is complete, the dura mater is exposed and opened on each side of the transverse and superior sagittal sinuses. This step is crucial for accessing the tentorium cerebelli.
  • Coagulation and Incision: The dura mater is carefully coagulated and incised in the posterior portion of the falx cerebri, proceeding down to the straight sinus where the inferior sagittal sinus is identified, coagulated, and transected.
  • Tentorial Sectioning: The tentorium cerebelli is then coagulated and sectioned on both sides of the straight sinus, ensuring that the procedure is performed as close as possible to the sinuses to occlude small arterial branches that supply the dural malformation.
  • Dura Closure: After the necessary interventions are completed, the dura is closed, and the neck muscles and skin are replaced and sutured together to promote healing.

3. Post-Procedure

Post-procedure care following a craniotomy for section of the tentorium cerebelli involves monitoring the patient for any signs of complications, such as infection or excessive bleeding. Patients may require intensive care to manage intracranial pressure and neurological status. Recovery may involve pain management and rehabilitation to address any deficits resulting from the procedure. Follow-up imaging may be necessary to assess the success of the intervention and ensure that there are no further complications.
Short Descr INCISE SKULL FOR SURGERY
Medium Descr CRANIOTOMY SECTION TENTORIUM CEREBELLI SPX
Long Descr Craniotomy for section of tentorium cerebelli (separate procedure)
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 9 - 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 Not applicable/unspecified.
CCS Clinical Classification 1 - Incision and excision of CNS
Date
Action
Notes
2015-01-01 Deleted Code deleted
Pre-1990 Added Code added.
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