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The CPT® Code 61591 describes a complex surgical procedure known as the infratemporal post-auricular approach to the middle cranial fossa. This approach is utilized to access various anatomical structures and lesions located in critical areas such as the internal auditory meatus, petrous apex, tentorium, cavernous sinus, parasellar area, and infratemporal fossa. The procedure involves a meticulous incision that begins in the temporal region, extending behind the ear over the mastoid bone and down into the neck. This incision is strategically designed to provide optimal access and control over the internal carotid artery, which is essential for the safe navigation of neurovascular structures during surgery. During the operation, a scalp flap is elevated, and the temporalis muscle is carefully detached from the temporal fossa to facilitate access to the underlying structures. A mastoidectomy is performed, which involves the removal of mastoid air cells to enhance visibility and access to the middle cranial fossa. Additionally, the resection of the sigmoid sinus may be necessary to further expose the surgical field. It is important to note that the middle ear may be sacrificed during this approach, depending on the specific requirements of the procedure. The facial nerve, a critical structure in the vicinity, is typically skeletonized and protected throughout the operation; however, if the tumor has invaded the facial nerve, resection may be unavoidable. A temporal craniotomy is then executed, with the precise placement of osteotomies determined by the lesion's location. The frontal lobe is retracted to allow for further dissection, and soft tissues are meticulously dissected off the infratemporal skull base. If the middle ear remains intact, the auditory canal may be decompressed and mobilized, along with the petrous carotid artery, to ensure that all neurovascular structures are identified and preserved before the dissection of the lesion commences. This comprehensive approach underscores the complexity and precision required in performing this surgical intervention.
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The infratemporal post-auricular approach to the middle cranial fossa, as described by CPT® Code 61591, is indicated for the surgical management of various extradural or intradural lesions. These lesions may be located in the following areas:
The procedure begins with the creation of an incision in the temporal area, which extends behind the ear over the mastoid bone and down into the neck. This incision is crucial for providing access to the internal carotid artery and surrounding structures.
Post-procedure care following the infratemporal post-auricular approach to the middle cranial fossa involves monitoring for any complications related to the surgery, such as bleeding, infection, or neurological deficits. Patients may require pain management and close observation in a recovery setting. The surgical site will need to be kept clean and dry, and follow-up appointments will be necessary to assess healing and recovery. Rehabilitation may be indicated depending on the extent of the surgery and any neurological impact experienced by the patient. Additionally, the preservation of cranial nerve function will be evaluated during the recovery process.
| Short Descr | INFRATEMPORAL APPROACH/SKULL | Medium Descr | INFRATEMPO MID CRANIAL FOSSA W/WO DCOMPR&/MOBI | Long Descr | Infratemporal post-auricular approach to middle cranial fossa (internal auditory meatus, petrous apex, tentorium, cavernous sinus, parasellar area, infratemporal fossa) including mastoidectomy, resection of sigmoid sinus, with or without decompression and/or mobilization of contents of auditory canal or petrous carotid artery | 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. | 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.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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). | 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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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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