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The procedure described by CPT® Code 61530 refers to a craniectomy that involves a bone flap craniotomy using a transtemporal (mastoid) approach specifically for the excision of a cerebellopontine angle tumor. The cerebellopontine angle is a critical anatomical region located at the junction of the cerebellum and the brainstem, filled with cerebrospinal fluid, and bordered medially by the brainstem, laterally by the temporal bone, and superiorly by the cerebellum. This area is significant as it is the most common site for intracranial posterior fossa tumors, with acoustic neuromas being the most prevalent type. Acoustic neuromas, also known as vestibular schwannomas, are slow-growing tumors that arise from the acoustic nerve, which is situated behind the ear and beneath the cerebellum. Other tumors that may occur in this region include various benign tumors and both primary and metastatic malignant tumors. The procedure combines the transtemporal approach with a middle and posterior fossa craniectomy to enhance the surgical exposure necessary for effective tumor removal. This approach allows for the identification and preservation of critical neural structures while facilitating the complete excision of the tumor, thereby addressing the underlying pathology effectively.
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The procedure described by CPT® Code 61530 is indicated for the excision of tumors located in the cerebellopontine angle, particularly when these tumors are affecting the surrounding neural structures. The most common indication for this procedure is the presence of an acoustic neuroma, which is a benign tumor of the vestibular nerve. Other indications may include the presence of other types of benign tumors or malignant tumors that require surgical intervention to alleviate symptoms or prevent further complications.
The procedure involves several critical steps to ensure effective tumor removal while minimizing damage to surrounding structures. Initially, a skin incision is made either anterior or posterior to the external auditory meatus. This incision allows access to the underlying tissues. The temporalis muscle is then incised or reflected inferiorly to expose the temporal bone. A temporal craniotomy is performed, which involves removing a section of the skull to access the brain. Following this, the dura mater, which is the outer protective covering of the brain, is elevated from the floor of the middle cranial fossa, allowing for further dissection. The temporal lobe dura is also elevated off the surface of the temporal bone to provide a clear view of the surgical field.
Next, the petrosal sinus is identified and carefully protected during the dissection. The surgical team continues to dissect until the lateral posterior end of the internal auditory canal is exposed. The greater superficial petrosal nerve is identified and traced retrograde to the geniculate ganglion, which is then completely exposed. The labyrinthine portion of the nerve is also identified and followed medially and inferiorly into the internal auditory canal. Once the medial end of the internal auditory canal is located, overlying bone is removed to achieve adequate exposure, including the superior vestibular nerve, which innervates the ampulla.
After achieving sufficient exposure, the tumor is completely removed. To prevent cerebrospinal fluid leakage, bone is used to fill any air cells, and fat is packed into the internal auditory canal. The dura mater is then repaired to restore the protective covering of the brain. Finally, the skull is replaced and secured using miniplates, and the soft tissues are closed in layers to complete the procedure.
Post-procedure care involves monitoring the patient for any complications that may arise following the surgery. Patients are typically observed for signs of cerebrospinal fluid leakage, infection, or neurological deficits. Pain management is also an essential aspect of post-operative care. The recovery process may vary depending on the extent of the surgery and the patient's overall health. Follow-up appointments are necessary to assess the surgical site, monitor for any recurrence of the tumor, and evaluate the patient's neurological status. Rehabilitation may be required to address any balance or hearing issues resulting from the procedure.
| Short Descr | REMOVAL OF BRAIN LESION | Medium Descr | CRNEC EXC CEREBELLOPNTIN ANGLE TUM MID/POSTFOSSA | Long Descr | Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of cerebellopontine angle tumor; combined with middle/posterior fossa craniotomy/craniectomy | 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) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | 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 | 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. | 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. | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| Pre-1990 | Added | Code added. |
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