How To Use CPT Code 61591

CPT 61591 describes the infratemporal post-auricular approach to the middle cranial fossa, which involves accessing various areas such as the internal auditory meatus, petrous apex, tentorium, cavernous sinus, parasellar area, and infratemporal fossa. 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 61591?

CPT 61591 is a code used to describe a specific surgical approach to the middle cranial fossa. It involves accessing various areas such as the internal auditory meatus, petrous apex, tentorium, cavernous sinus, parasellar area, and infratemporal fossa. This approach may include procedures such as mastoidectomy, resection of the sigmoid sinus, and decompression or mobilization of the contents of the auditory canal or petrous carotid artery.

2. Official Description

The official description of CPT code 61591 is the “Infratemporal post-auricular approach to middle cranial fossa (internal auditory meatus, petrous apex, tentorium, cavernous sinus, parasellar area, infratemporal fossa) including mastoidectomy, resection of sigmoid sinus, with or without decompression and/or mobilization of contents of auditory canal or petrous carotid artery.”

3. Procedure

1. The surgeon utilizes an infratemporal post-auricular approach to access the middle cranial fossa.
2. This approach may involve a mastoidectomy, which is the removal of a portion of the posterior temporal bone.
3. The surgeon may also perform a resection of the sigmoid sinus, which is a curved sinus located in the skull.
4. In some cases, decompression and/or mobilization of the contents of the auditory canal or petrous carotid artery may be necessary.
5. The specific techniques used will depend on the location and size of the lesion or defect being addressed.

4. Qualifying circumstances

CPT 61591 is typically performed when there is a need to access and treat a lesion or defect in the middle cranial fossa. This approach may be necessary for conditions such as tumors, infections, or other abnormalities in the areas mentioned in the official description. The decision to use this approach will depend on the specific circumstances of each patient and the expertise of the surgeon.

5. When to use CPT code 61591

CPT code 61591 should be used when the infratemporal post-auricular approach is performed to access and treat a lesion or defect in the middle cranial fossa. It is important to accurately document the specific areas accessed and any additional procedures performed during the surgery.

6. Documentation requirements

To support a claim for CPT 61591, the surgeon must document the following information:

• Reason for the surgery and the need for the infratemporal post-auricular approach
• Specific areas accessed during the procedure, such as the internal auditory meatus, petrous apex, tentorium, cavernous sinus, parasellar area, and infratemporal fossa
• Details of any additional procedures performed, such as mastoidectomy, resection of the sigmoid sinus, or decompression/mobilization of the auditory canal or petrous carotid artery
• Date and duration of the surgery
• Any complications or unexpected findings during the procedure
• Signature of the surgeon performing the procedure

7. Billing guidelines

When billing for CPT 61591, it is important to ensure that the documentation supports the use of this specific approach and the procedures performed. It is also important to follow any specific billing guidelines provided by the payer or coding guidelines. CPT code 61591 should not be reported with other codes unless additional procedures or services were performed that are separately billable.

8. Historical information

CPT code 61591 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 patient with a tumor in the petrous apex undergoes surgery using the infratemporal post-auricular approach to access and remove the tumor.
2. A patient with a defect in the cavernous sinus requires surgery using the infratemporal post-auricular approach to repair the defect.
3. A patient with an aneurysm in the parasellar area undergoes surgery using the infratemporal post-auricular approach to perform aneurysm clipping.
4. A patient with a lesion in the internal auditory meatus requires surgery using the infratemporal post-auricular approach to remove the lesion.
5. A patient with a tumor in the infratemporal fossa undergoes surgery using the infratemporal post-auricular approach to excise the tumor.
6. A patient with a defect in the tentorium requires surgery using the infratemporal post-auricular approach to repair the defect.
7. A patient with a lesion in the petrous carotid artery undergoes surgery using the infratemporal post-auricular approach to address the lesion.
8. A patient with a tumor in the sigmoid sinus requires surgery using the infratemporal post-auricular approach to remove the tumor.
9. A patient with an infection in the internal auditory meatus undergoes surgery using the infratemporal post-auricular approach to drain the infection.
10. A patient with a lesion in the parasellar area requires surgery using the infratemporal post-auricular approach to remove the lesion.