How To Use CPT Code 61592

CPT 61592 describes the orbitocranial zygomatic approach to the middle cranial fossa, which involves accessing the cavernous sinus and carotid artery, clivus, basilar artery, or petrous apex. 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 61592?

CPT 61592 is a code used to describe the orbitocranial zygomatic approach to the middle cranial fossa. This procedure involves accessing specific areas such as the cavernous sinus and carotid artery, clivus, basilar artery, or petrous apex. The selection of this approach depends on the location and size of the lesion being treated.

2. Official Description

The official description of CPT code 61592 is: ‘Orbitocranial zygomatic approach to middle cranial fossa (cavernous sinus and carotid artery, clivus, basilar artery or petrous apex) including osteotomy of zygoma, craniotomy, extra- or intradural elevation of temporal lobe.’

3. Procedure

1. The patient is prepared and draped in a sterile manner and placed in the lateral supine position.
2. The healthcare provider uses a skull-based approach to explore the hollow area bounded by the sphenoid and temporal bones, which contains the tissue defect.
3. Procedures such as controlled fracture of the zygomatic bone and separation or retraction of the lower lobe of the cerebral hemisphere may be performed to achieve better access to the diseased tissue.
4. The provider performs osteotomy of the zygoma, craniotomy, and extra- or intradural elevation of the temporal lobe as necessary.
5. The specific approach used will depend on the location and size of the lesion being treated.

4. Qualifying circumstances

CPT 61592 is used when the healthcare provider needs to access the middle cranial fossa using an orbitocranial zygomatic approach. This approach may be necessary for conditions involving the cavernous sinus and carotid artery, clivus, basilar artery, or petrous apex. The procedure may include osteotomy of the zygoma, craniotomy, and extra- or intradural elevation of the temporal lobe.

5. When to use CPT code 61592

CPT code 61592 should be used when the healthcare provider performs the orbitocranial zygomatic approach to the middle cranial fossa, including the specified areas of the cavernous sinus and carotid artery, clivus, basilar artery, or petrous apex. This code should be used when the procedure involves osteotomy of the zygoma, craniotomy, and extra- or intradural elevation of the temporal lobe.

6. Documentation requirements

To support a claim for CPT 61592, the healthcare provider must document the following information:

• Specific areas accessed during the procedure, such as the cavernous sinus and carotid artery, clivus, basilar artery, or petrous apex
• Details of the approach used, including osteotomy of the zygoma, craniotomy, and extra- or intradural elevation of the temporal lobe
• Date of the procedure
• Start and end time of the procedure
• Any additional procedures performed during the same session
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 61592, ensure that the procedure meets the specific criteria outlined in the code description. It is important to accurately document the areas accessed and the specific approach used. Additionally, be aware of any additional procedures performed during the same session and report them separately if necessary. Follow any specific guidelines provided by payers regarding the use of this code.

8. Historical information

CPT 61592 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 orbitocranial zygomatic approach to access the cavernous sinus and carotid artery for the removal of a tumor.
2. A patient undergoes the orbitocranial zygomatic approach to treat a basilar artery aneurysm.
3. The healthcare provider performs osteotomy of the zygoma, craniotomy, and extra- or intradural elevation of the temporal lobe to access the petrous apex for the treatment of a lesion.
4. A patient with a clivus tumor undergoes the orbitocranial zygomatic approach for surgical removal.
5. The healthcare provider performs the orbitocranial zygomatic approach to access the basilar artery for the treatment of a vascular malformation.
6. A patient with a cavernous sinus tumor undergoes the orbitocranial zygomatic approach for tumor resection.
7. The healthcare provider performs osteotomy of the zygoma, craniotomy, and extra- or intradural elevation of the temporal lobe to access the carotid artery for the treatment of a stenosis.
8. A patient with a petrous apex lesion undergoes the orbitocranial zygomatic approach for surgical intervention.
9. The healthcare provider performs the orbitocranial zygomatic approach to access the clivus for the treatment of a chordoma.
10. A patient with a basilar artery aneurysm undergoes the orbitocranial zygomatic approach for aneurysm clipping.