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The CPT® Code 61581 refers to a surgical procedure known as a craniofacial approach to the anterior cranial fossa, specifically performed in an extradural manner. This complex procedure is designed to expose lesions located in the extradural space, which is the area outside the dura mater, the outermost layer of the protective covering of the brain. The approach involves a combination of surgical techniques, including lateral rhinotomy, orbital exenteration, ethmoidectomy, sphenoidectomy, and/or maxillectomy. Each of these techniques serves a specific purpose in accessing the targeted area effectively. The lateral rhinotomy involves an incision that begins at the medial edge of the eyebrow and extends down the side of the nose, allowing access to the nasal and facial structures. The orbital exenteration entails the removal of the eyeball and surrounding orbital contents, which is crucial when dealing with malignant tumors that have invaded the periorbital region. Ethmoidectomy and sphenoidectomy involve the complete resection of the mucosa and bone of the ethmoid and sphenoid sinuses, respectively, to facilitate access to the extradural lesion. This procedure is typically indicated for patients with malignant tumors that have spread to the maxillary sinus and may require extensive resection of surrounding structures to ensure complete removal of the tumor and to preserve neurovascular integrity during the operation.
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The procedure described by CPT® Code 61581 is indicated for the surgical management of malignant tumors that have invaded the maxillary sinus and potentially the periorbital region. The following conditions may warrant this approach:
The procedure involves several critical steps to ensure effective access to the extradural lesion:
Post-procedure care involves monitoring for complications related to the extensive surgical intervention. Patients may require pain management and close observation for signs of infection or neurological deficits due to the involvement of critical structures such as the facial nerve. Recovery may involve rehabilitation to address any functional impairments resulting from the surgery, particularly concerning facial movement and appearance. Follow-up appointments are essential to assess healing and to plan any additional treatments, such as radiation or chemotherapy, if indicated for the underlying malignancy.
| Short Descr | CRANIOFACIAL APPROACH SKULL | Medium Descr | CRANIOFACIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ | Long Descr | Craniofacial approach to anterior cranial fossa; extradural, including lateral rhinotomy, orbital exenteration, ethmoidectomy, sphenoidectomy and/or maxillectomy | 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) | 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) | 2 - Team surgeons permitted; pay by report. | 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) |
| 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. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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). | 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. | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | 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) |
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| 2011-01-01 | Changed | Short description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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