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The CPT® Code 61585 describes a complex surgical procedure known as the orbitocranial approach to the anterior cranial fossa, which is performed extradurally. This approach is primarily utilized for addressing various conditions affecting the anterior cranial fossa, including the resection of malignant tumors, management of infectious diseases, and treatment of traumatic injuries to the orbit and paranasal sinuses. A key component of this procedure is orbital exenteration, which involves the removal of the periorbita, eyeball, associated appendages, eyelids, and the surrounding skin. The surgical technique begins with an incision in the scalp, strategically placed along the inferior border of the zygomatic arch and extending upward and forward to intersect at the contralateral midpupillary line, ensuring minimal visibility post-operation. The procedure requires careful elevation of the frontal periosteum while preserving its attachment to the bone, allowing for optimal access to the underlying structures. The dissection continues with the mobilization of the temporalis muscle and the creation of a fascial cuff, which aids in the reapproximation of the muscle layer after the procedure. The meticulous dissection of the periorbita and the exposure of the supraorbital ridge are critical for achieving the necessary access to the orbit. The procedure may also involve the elevation of the frontal and/or temporal lobes, which can be performed without orbital exenteration, as indicated by the related CPT® Code 61584. The classification of orbital exenteration is further detailed, with four types based on the extent of tissue removal, ranging from sparing the palpebral skin and conjunctiva to complete removal of the eyeball, eyelids, and involved bone structures. This comprehensive description underscores the complexity and precision required in performing the orbitocranial approach to the anterior cranial fossa with orbital exenteration.
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The orbitocranial approach to the anterior cranial fossa, as described by CPT® Code 61585, is indicated for several specific medical conditions and scenarios. These include:
The orbitocranial approach to the anterior cranial fossa involves several detailed procedural steps, which are as follows:
Post-procedure care following the orbitocranial approach to the anterior cranial fossa with orbital exenteration involves careful monitoring of the patient for any complications. Expected recovery may include managing pain, monitoring for signs of infection, and ensuring proper healing of the surgical site. Patients may require follow-up appointments to assess the surgical outcome and to manage any potential complications related to the removal of orbital contents. Additionally, rehabilitation may be necessary to address any functional impairments resulting from the procedure, particularly if there has been significant alteration to the facial structure or vision. The surgical team will provide specific instructions regarding wound care, activity restrictions, and signs of complications that should prompt immediate medical attention.
| Short Descr | ORBITOCRANIAL APPROACH/SKULL | Medium Descr | ORBITOCRANIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ | Long Descr | Orbitocranial approach to anterior cranial fossa, extradural, including supraorbital ridge osteotomy and elevation of frontal and/or temporal lobe(s); with orbital exenteration | 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) | 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. | 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. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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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| 1994-01-01 | Added | First appearance in code book in 1994. |