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Craniosynostosis is a congenital condition characterized by the premature fusion of one or more cranial sutures in infants, which can lead to significant complications. The cranial sutures are fibrous joints that connect the bones of the skull, allowing for growth and development of the brain during infancy and early childhood. When these sutures close too early, it can result in increased intracranial pressure, which may impair brain development and lead to cognitive and developmental delays. Additionally, the abnormal closure of sutures can cause distinctive head shapes, such as the cloverleaf skull associated with multiple suture synostosis. This condition can occur independently or as part of various syndromes, including Crouzon, Apert, Carpenter, Chotzen, or Pfeiffer syndrome, which may present with other physical abnormalities. The treatment for craniosynostosis typically involves surgical intervention to correct the shape of the skull and alleviate pressure on the brain. The procedure involves extensive craniectomy, where multiple pieces or wedges of bone are excised from the skull to allow for proper reshaping and reconfiguration of the cranial structure. This surgical approach aims to restore normal head shape and promote healthy brain development without the need for bone grafts, as indicated by CPT® Code 61558.
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The procedure described by CPT® Code 61558 is indicated for the treatment of multiple cranial suture craniosynostosis, particularly in cases where the condition leads to significant cranial deformities such as a cloverleaf skull. This surgical intervention is necessary when the premature closure of cranial sutures results in increased intracranial pressure, impaired brain development, and abnormal head shape. The procedure is performed to correct these issues and to prevent further complications associated with craniosynostosis.
The surgical procedure for CPT® Code 61558 involves several critical steps to effectively address craniosynostosis. First, the surgeon marks the incision lines on the scalp, ensuring precise alignment with the areas of the skull that require intervention. Following this, an incision is made in the skin, and scalp flaps are created to provide complete exposure of the skull's surface. This exposure is essential for the subsequent steps of the procedure. Next, the surgeon marks the specific bone cuts on the skull, which will guide the removal of the affected bone segments. Burr holes are then drilled along the planned craniectomy lines to facilitate the cutting of the bone. These burr holes serve as entry points for the craniotome or saw, which is used to connect the holes and create the necessary openings in the skull. Once the bone cuts are made, the surgeon carefully removes the wedges or pieces of bone that have been identified for excision. After removal, these bone segments are reshaped and reoriented to achieve the best possible cosmetic outcome. Finally, the reconfigured bones are secured in place using miniplates and screws, ensuring stability and proper alignment. The procedure concludes with the closure of the incisions in layers, promoting optimal healing and recovery.
After the extensive craniectomy procedure, patients typically require careful monitoring in a postoperative setting to assess for any complications. Expected recovery may involve managing pain and monitoring for signs of infection at the incision sites. Patients may also need to be observed for any neurological changes due to the nature of the surgery. Follow-up appointments are essential to evaluate the healing process and the cosmetic results of the surgery. Additional considerations may include guidance on activity restrictions during the recovery period to ensure proper healing and to prevent any undue stress on the surgical site.
| Short Descr | EXCISION OF SKULL/SUTURES | Medium Descr | XTN CRANIECT MULTIPLE SUTURE CRANIOSYNOSTOSIS | Long Descr | Extensive craniectomy for multiple cranial suture craniosynostosis (eg, cloverleaf skull); not requiring bone grafts | 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 | 1 | CCS Clinical Classification | 9 - Other OR therapeutic nervous system 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) |
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| 1991-01-01 | Added | First appearance in code book in 1991. |
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