How To Use CPT Code 61590

CPT 61590 describes the infratemporal pre-auricular approach to the middle cranial fossa, which involves accessing the skull base through the infratemporal area in front of the external ear. 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 61590?

CPT 61590 can be used to describe the surgical approach to the middle cranial fossa, specifically through the infratemporal area in front of the external ear. This approach allows the healthcare provider to access and treat lesions or defects at the base of the skull. The procedure may involve disarticulation of the mandible, parotidectomy, craniotomy, decompression and/or mobilization of the facial nerve, and/or petrous carotid artery. It is important to note that this code does not include internal fixation or bone graft procedures.

2. Official Description

The official description of CPT code 61590 is: ‘Infratemporal pre-auricular approach to middle cranial fossa (parapharyngeal space, infratemporal and midline skull base, nasopharynx), with or without disarticulation of the mandible, including parotidectomy, craniotomy, decompression and/or mobilization of the facial nerve and/or petrous carotid artery.’

3. Procedure

1. The healthcare provider utilizes the infratemporal pre-auricular approach to access the middle cranial fossa.
2. This approach involves accessing the skull base through the infratemporal area in front of the external ear.
3. The provider may perform disarticulation of the mandible, parotidectomy, craniotomy, decompression and/or mobilization of the facial nerve, and/or petrous carotid artery.
4. These procedures allow the provider to treat lesions or defects at the base of the skull.
5. The specific techniques used will depend on the location and size of the lesion.

4. Qualifying circumstances

CPT 61590 is used when the healthcare provider needs to access the middle cranial fossa through the infratemporal area in front of the external ear. This approach is typically used to treat lesions or defects at the base of the skull, such as those involving the parapharyngeal space, infratemporal and midline skull base, or nasopharynx. The procedure may involve disarticulation of the mandible, parotidectomy, craniotomy, decompression and/or mobilization of the facial nerve, and/or petrous carotid artery.

5. When to use CPT code 61590

CPT code 61590 should be used when the healthcare provider performs the infratemporal pre-auricular approach to access the middle cranial fossa. This code is appropriate when the procedure involves the treatment of lesions or defects at the base of the skull, such as those involving the parapharyngeal space, infratemporal and midline skull base, or nasopharynx. It is important to note that this code does not include internal fixation or bone graft procedures.

6. Documentation requirements

To support a claim for CPT code 61590, the healthcare provider must document the following information:

• Reason for the procedure and the specific location of the lesion or defect
• Details of the infratemporal pre-auricular approach used
• Description of any additional procedures performed, such as disarticulation of the mandible, parotidectomy, craniotomy, decompression and/or mobilization of the facial nerve, and/or petrous carotid artery
• Date of the procedure and the duration of the surgery
• Any complications or unexpected findings during the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 61590, ensure that the procedure involves the infratemporal pre-auricular approach to the middle cranial fossa. This code should not be reported with codes for internal fixation or bone graft procedures. It is important to accurately document the details of the procedure and any additional procedures performed. If the documentation does not provide enough information to determine the correct code, it is recommended to query the healthcare provider for clarification.

8. Historical information

CPT code 61590 was added to the Current Procedural Terminology system on January 1, 1994. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A healthcare provider performs the infratemporal pre-auricular approach to access the middle cranial fossa and treats a lesion in the parapharyngeal space.
2. The provider utilizes the infratemporal pre-auricular approach to access the middle cranial fossa and performs a parotidectomy to treat a defect in the infratemporal and midline skull base.
3. A patient undergoes the infratemporal pre-auricular approach to the middle cranial fossa for decompression and mobilization of the facial nerve to address a lesion in the nasopharynx.
4. The healthcare provider performs the infratemporal pre-auricular approach to access the middle cranial fossa and treats a defect in the parapharyngeal space, without disarticulation of the mandible.
5. A patient undergoes the infratemporal pre-auricular approach to the middle cranial fossa for decompression and mobilization of the facial nerve, without parotidectomy.