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The transcondylar (far lateral) approach to the posterior cranial fossa, jugular foramen, or midline skull base is a surgical technique utilized primarily for accessing and treating conditions affecting the lower part of the brain and surrounding structures. This approach is particularly relevant for the resection of neoplastic tumors, which are abnormal growths that can be benign or malignant, as well as vascular lesions that may compromise blood flow or nerve function. The procedure also facilitates decompression of the vertebral artery and cranial nerves, which can alleviate symptoms associated with nerve compression or vascular obstruction. The posterior fossa is located at the base of the skull and houses critical components of the central nervous system, including the cerebellum and brainstem, which are essential for motor control and vital functions. The jugular foramen serves as a passageway for important cranial nerves (IX, X, and XI) and contains the sigmoid sinus, which transitions into the jugular vein, playing a crucial role in venous drainage from the brain. The surgical approach involves a meticulous incision and dissection through various layers of tissue, allowing for direct access to these vital structures while minimizing damage to surrounding areas. This technique requires careful planning and execution to ensure optimal outcomes and reduce the risk of complications.
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The transcondylar (far lateral) approach is indicated for various conditions affecting the posterior cranial fossa, jugular foramen, or midline skull base. The following are specific indications for this procedure:
The transcondylar (far lateral) approach involves several detailed procedural steps to ensure effective access to the targeted anatomical structures. Each step is critical for the success of the surgery:
Post-procedure care following the transcondylar (far lateral) approach involves monitoring for any complications and ensuring proper recovery. Patients are typically observed for neurological function and signs of infection. Pain management is provided as needed, and the surgical site is monitored for any signs of hematoma or cerebrospinal fluid leakage. Follow-up imaging may be required to assess the surgical site and ensure that the intended decompression or resection has been achieved. Rehabilitation may also be necessary, depending on the extent of the procedure and the patient's overall condition.
| Short Descr | TRANSCONDYLAR APPROACH/SKULL | Medium Descr | TRNSCONDLR POST CRNL FOSSA DCOMPR ART W/WO MOBIL | Long Descr | Transcondylar (far lateral) approach to posterior cranial fossa, jugular foramen or midline skull base, including occipital condylectomy, mastoidectomy, resection of C1-C3 vertebral body(s), decompression of vertebral artery, with or without mobilization | 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 | 142 - Partial excision bone |
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). | 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. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 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. | 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) | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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