© Copyright 2025 American Medical Association. All rights reserved.
The procedure described by CPT® Code 61607 involves the resection or excision of neoplastic, vascular, or infectious lesions located in the parasellar area, cavernous sinus, clivus, or midline skull base. This area is critical as it houses important structures such as the hypothalamus, optic chiasm, and pituitary gland, all of which are protected by the dura mater. The approach to access these lesions is performed through the sella turcica, which is a central region of the sphenoid bone. During the procedure, careful attention is given to preserve vital blood vessels and cranial nerves, particularly the carotid arteries and cranial nerves III, IV, and VI, which are situated within the cavernous sinus, as well as cranial nerve V, which is located outside its walls. The dura mater forms the inner walls of the cavernous sinus, ensuring that the pituitary gland remains separated from the brain tissue. The surgical technique may involve opening the dural tent to access the lesion, which is then excised or debulked as much as possible. Post-excision, the surgical site is meticulously checked for any bleeding, and the dural defect is repaired to prevent cerebrospinal fluid leakage. This procedure is significant in treating conditions affecting the midline skull base and surrounding structures, ensuring both the removal of the lesion and the preservation of critical neurological functions.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 61607 is indicated for the treatment of various lesions located in the parasellar area, cavernous sinus, clivus, or midline skull base. These lesions may include:
The procedure begins with accessing the parasellar area through a separately reportable approach. The surgeon performs a resection or excision of the lesion by first navigating through the sella turcica, which is the central area of the sphenoid bone. This area is covered by dura and houses critical structures such as the hypothalamus, optic chiasm, and pituitary gland. The surgical approach extends laterally into the cavernous sinus, which contains a complex network of blood vessels and cranial nerves. During the excision, the surgeon takes great care to preserve the carotid arteries and cranial nerves III, IV, and VI located within the cavernous sinus, as well as cranial nerve V situated outside its walls. The dural tent is then opened using either blunt or sharp dissection towards the clivus, which is the shallow depression behind the dorsum sellae. This area slopes sharply backward to the anterior portion of the basilar occipital bone or midline skull base, where it connects with the sphenoid bone. The lesion is ideally removed en bloc, meaning as a single piece, whenever feasible. If complete removal is not possible, the lesion is debulked to the greatest extent achievable. After the excision, the surgical area is thoroughly checked for any bleeding. The dural defect created during the procedure is repaired using sutures for primary closure or by interposing graft material, which may include autologous pericranium or synthetic materials such as acellular human dermis or collagen matrix, to ensure a watertight seal and prevent cerebrospinal fluid (CSF) leakage. Additionally, any extradural deficit may be filled with autologous graft material, such as fascia, fat, or bone. The closure of the skull deficit is accomplished using the patient’s excised bone, cadaver bone graft, or a metal plate. The incision is sutured in layers, and the skin may be closed using staples. It is important to note that if the dura is not opened during the procedure for the lesion to be excised or resected, the appropriate code to report is CPT® Code 61607.
Post-procedure care involves monitoring the patient for any signs of complications, such as bleeding or cerebrospinal fluid leakage. The surgical site is assessed for proper healing, and any necessary follow-up imaging may be conducted to ensure that the lesion has been adequately addressed. Patients may require pain management and supportive care during their recovery. The healthcare team will provide instructions on activity restrictions and signs of potential complications that the patient should report. Overall, the focus is on ensuring a safe recovery and minimizing the risk of adverse outcomes following the surgical intervention.
| Short Descr | RESECT/EXCISE CRANIAL LESION | Medium Descr | RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB XDRL | Long Descr | Resection or excision of neoplastic, vascular or infectious lesion of parasellar area, cavernous sinus, clivus or midline skull base; 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.
| 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. | 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. | 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 | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 1994-01-01 | Added | First appearance in code book in 1994. |