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The craniofacial approach to the anterior cranial fossa (ACF) is a surgical technique utilized primarily for accessing and treating various conditions affecting the ACF, including neoplastic tumors and vascular lesions located within the sinus and orbit. The ACF is anatomically defined by the frontal, ethmoid, and sphenoid bones, with its lateral boundaries formed by these structures. The floor of the ACF corresponds to the roof of the orbits, while centrally, it aligns with the vault of the nasal cavity and the fovea ethmoidalis. This approach can be performed through either a unilateral or bifrontal craniotomy, which involves making incisions in the scalp to gain access to the underlying cranial structures. The procedure entails careful dissection through multiple layers of tissue, including the subcutaneous tissue, galea, and superficial temporalis fascia, to expose the bone. The surgical team may harvest a flap from the pericranium or temporalis fascia for use in closing the dura after the procedure. The craniofacial approach is critical for enabling surgeons to perform necessary interventions while minimizing damage to surrounding tissues and structures.
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The craniofacial approach to the anterior cranial fossa is indicated for various conditions that necessitate surgical intervention in this region. The following are the explicitly provided indications for this procedure:
The craniofacial approach involves several detailed procedural steps to ensure effective access to the anterior cranial fossa. The following steps outline the process:
Post-procedure care following the craniofacial approach to the anterior cranial fossa involves monitoring for complications and ensuring proper recovery. Patients may require close observation for signs of infection, bleeding, or neurological deficits. Pain management and wound care are essential components of post-operative care. The expected recovery period may vary based on the extent of the procedure and the patient's overall health. Follow-up appointments are necessary to assess healing and to monitor for any potential complications that may arise after surgery.
| Short Descr | CRANIOFACIAL APPROACH SKULL | Medium Descr | CRANFCL ANT CRANIAL FOSSA UNI/BI CRANIOT/OSTEOT | Long Descr | Craniofacial approach to anterior cranial fossa; extradural, including unilateral or bifrontal craniotomy, elevation of frontal lobe(s), osteotomy of base of anterior cranial fossa | 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) | 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 | 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. | 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). | 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. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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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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