How To Use CPT Code 61564

CPT 61564 describes the excision of a benign tumor of the cranial bone, along with optic nerve decompression. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 61564?

CPT 61564 can be used to describe the excision of a benign tumor of the cranial bone, specifically involving the intra and extracranial areas. In addition to the tumor removal, this code also includes optic nerve decompression. It is important to note that for reconstruction purposes, separate codes (21181-21183) should be used.

2. Official Description

The official description of CPT code 61564 is: ‘Excision, intra and extracranial, benign tumor of cranial bone (eg, fibrous dysplasia); with optic nerve decompression.’ It is worth mentioning that this code does not cover the reconstruction aspect, which requires the use of different codes.

3. Procedure

1. During this procedure, the healthcare provider begins by making an incision in the scalp over the cranial bone tumor.
2. Next, the affected portion of the skull bones is carefully removed.
3. The provider then proceeds to decompress the optic nerve by removing the roof of the optic nerve canal, which is the bony structure through which the optic nerve passes.
4. Afterwards, the provider remodels the skull defect to restore a normal shape.
5. Finally, the scalp layers are sutured together, and the wound is covered with a sterile dressing.

4. Qualifying circumstances

CPT 61564 is applicable when a patient requires the excision of a benign tumor in the cranial bone, such as fibrous dysplasia. Additionally, optic nerve decompression must be performed as part of the procedure. It is important to note that for reconstruction purposes, separate codes should be used.

5. When to use CPT code 61564

CPT code 61564 should be used when a healthcare provider performs the excision of a benign tumor in the cranial bone, along with optic nerve decompression. It is important to ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT 61564, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for the excision of the benign cranial bone tumor
• Details of the optic nerve decompression performed
• Date of the procedure
• Specific steps taken during the excision and decompression
• Any additional procedures or techniques used
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 61564, it is important to ensure that the excision of the benign tumor and optic nerve decompression are performed. This code should not be reported if the provider does not perform optic nerve decompression. Additionally, it is crucial to follow any specific billing guidelines provided by insurance companies or payers.

8. Historical information

CPT 61564 was added to the Current Procedural Terminology system on January 1, 1991. It is worth noting that there have been no updates or changes to the code since its addition. However, it is always important to stay updated with any changes or revisions to coding guidelines.

9. Examples

1. A neurosurgeon performs the excision of a benign cranial bone tumor, along with optic nerve decompression, for a patient with fibrous dysplasia.
2. A maxillofacial surgeon removes a benign tumor from the cranial bone and decompresses the optic nerve for a patient with osteoma.
3. A neurologist performs the excision of a benign tumor in the cranial bone, along with optic nerve decompression, for a patient with meningioma.
4. An otolaryngologist removes a benign cranial bone tumor and decompresses the optic nerve for a patient with chondroma.
5. A plastic surgeon performs the excision of a benign tumor in the cranial bone, along with optic nerve decompression, for a patient with osteoblastoma.
6. A neurosurgeon removes a benign cranial bone tumor and decompresses the optic nerve for a patient with hemangioma.
7. An orthopedic surgeon performs the excision of a benign tumor in the cranial bone, along with optic nerve decompression, for a patient with giant cell tumor.
8. A neurosurgeon removes a benign cranial bone tumor and decompresses the optic nerve for a patient with ossifying fibroma.
9. A maxillofacial surgeon performs the excision of a benign tumor in the cranial bone, along with optic nerve decompression, for a patient with osteochondroma.
10. An otolaryngologist removes a benign cranial bone tumor and decompresses the optic nerve for a patient with osteoid osteoma.