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The CPT® Code 61606 refers to the surgical procedure involving the resection or excision of neoplastic (tumor-related), vascular, or infectious lesions located in the infratemporal fossa, parapharyngeal space, and petrous apex. This procedure is classified as intradural, meaning it involves entering the endosteal dura, which is the protective layer surrounding the brain. The approach to access these areas is typically performed through a separately reportable method, allowing for a thorough exploration of the extradural space, which lies between the periosteal dura attached to the skull and the endosteal dura. During the procedure, the surgeon carefully removes any identified lesions while ensuring the preservation of critical anatomical structures, such as the maxillary artery and the trigeminal nerve along with its branches. The procedure may also involve examining and potentially resecting the cartilaginous Eustachian tube, as well as exploring the parapharyngeal space for any additional lesions. The pterygoid muscles are assessed, and if necessary, resected while taking care to preserve or ligate the pterygoid venous plexus. Furthermore, the procedure may require drilling or chiseling of the lateral and medial pterygoid plates and the petrous apex to effectively remove lesions. After the excision, any defects in the dura mater are repaired using sutures or graft materials to ensure a watertight seal, thereby preventing cerebrospinal fluid leakage. The procedure concludes with the closure of the incision in layers, which may involve wiring the zygomatic arch and using staples for the skin closure.
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The procedure described by CPT® Code 61606 is indicated for the treatment of various conditions affecting the infratemporal fossa, parapharyngeal space, and petrous apex. These indications include:
The procedure involves several critical steps to ensure effective resection or excision of the targeted lesions. These steps include:
Post-procedure care following the resection or excision of lesions in the infratemporal fossa, parapharyngeal space, and petrous apex is critical for recovery. Patients are typically monitored for any signs of complications, such as cerebrospinal fluid leakage or infection. Pain management is provided as needed, and patients may require follow-up imaging to assess the success of the procedure and ensure that no residual lesions remain. Instructions regarding activity restrictions and wound care are given to promote healing and prevent complications. The duration of recovery may vary based on the extent of the surgery and the individual patient's health status.
| Short Descr | RESECT/EXCISE CRANIAL LESION | Medium Descr | RESCJ/EXC LES ITPRL FOSSA SPACE APEX IDRL W/RPR | Long Descr | Resection or excision of neoplastic, vascular or infectious lesion of infratemporal fossa, parapharyngeal space, petrous apex; intradural, including dural repair, with or without graft | 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.
| 61611 | Addon Code MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Transection or ligation, carotid artery in petrous canal; without repair (List separately in addition to code for primary procedure) | 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) |
| 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). | 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. | 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. | 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. | 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). | 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 | RT | Right side (used to identify procedures performed on the right side of the body) | 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. |