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The CPT® Code 61600 refers to the surgical procedure involving the resection or excision of neoplastic, vascular, or infectious lesions located at the base of the anterior cranial fossa, specifically in an extradural context. This procedure is performed through a separately reported approach to access the anterior fossa. The surgical technique involves a lateral to medial resection or excision, during which the cribriform plate is carefully examined for any lesions. If lesions are found to involve the cribriform plate, osteotomies are performed to remove the plate en bloc along with the surrounding pathological tissue, while making every effort to preserve critical structures such as the olfactory bulb, cranial nerves, and blood vessels. In cases where further exploration is necessary, the sinus may be examined, and additional procedures such as rhinotomy, ethmoidectomy, maxillectomy, or maxillotomy may be performed as dictated by the surgical findings. If the dura mater can remain intact during the procedure, it is retracted to facilitate access to the underlying structures, and a drill or chisel is utilized to excise the bone as needed to complete the resection. Should the lesion extend into the dural space, the procedure involves dividing the dural sleeves along the olfactory nerves, opening the dura, and performing further excision of the lesion. Post-excision, the dural defect is repaired using sutures or graft materials, such as autologous pericranium or synthetic materials, to ensure a watertight seal and prevent cerebrospinal fluid leakage. The extradural defect is typically filled with autologous graft material, and the skull defect is closed using the patient’s own bone, cadaver bone graft, or a metal plate, with the incision being sutured in layers, and the skin may be closed with staples.
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The procedure described by CPT® Code 61600 is indicated for the removal of lesions that are neoplastic, vascular, or infectious in nature, located at the base of the anterior cranial fossa. These lesions may present symptoms that necessitate surgical intervention, including but not limited to:
The procedure begins with accessing the anterior fossa through a separately reported approach, which is crucial for ensuring proper visibility and access to the lesion. The surgeon performs an extradural resection or excision, moving from a lateral to a medial direction. During this phase, the cribriform plate is examined meticulously for any signs of lesion involvement. If the examination reveals that the cribriform plate is affected, the surgeon will perform osteotomies to remove the plate en bloc along with the surrounding neoplastic, vascular, or infectious tissue. Care is taken to preserve vital structures such as the olfactory bulb, cranial nerves, and blood vessels whenever possible. If further exploration is warranted, the sinus may be examined, and additional procedures such as rhinotomy, ethmoidectomy, maxillectomy, or maxillotomy may be performed based on the findings. Should the dura mater remain intact, it is retracted back to the planum sphenoidale, allowing the surgeon to utilize a drill or chisel to cut through the bone as necessary to complete the resection or excision of the lesion. In cases where the lesion extends intradurally, the surgeon will divide the dural sleeves that extend along the olfactory nerves, open the dura, and carry out the resection or excision of the remaining lesion. After the excision, the dural defect is repaired using sutures or by interposing graft material, which may include autologous pericranium or synthetic materials such as acellular human dermis or collagen matrix, to create a watertight seal and prevent cerebrospinal fluid leakage. The extradural defect is typically filled with autologous graft material, such as fascia or fat, to promote healing. Finally, the skull defect is closed using the patient’s excised bone, cadaver bone graft, or a metal plate, and the incision is sutured in layers, with the skin closure often accomplished using staples.
Post-procedure care following the resection or excision of lesions at the base of the anterior cranial fossa involves monitoring for any complications, particularly cerebrospinal fluid leaks, which can occur if the dural repair is not watertight. Patients may require imaging studies to ensure that the lesion has been adequately removed and to assess the integrity of the surrounding structures. Recovery may involve pain management and observation for any neurological deficits that could arise from the procedure. Follow-up appointments are essential to evaluate the surgical site and ensure proper healing, as well as to monitor for any recurrence of the lesions that were excised.
| Short Descr | RESECT/EXCISE CRANIAL LESION | Medium Descr | RESCJ/EXC LES BASE ANT CRANIAL FOSSA EXTRADURAL | Long Descr | Resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; extradural | 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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 | CR | Catastrophe/disaster related | 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 | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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