2025 CPT code 61591
Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Nervous System Feed
Infratemporal post-auricular approach to the middle cranial fossa, including mastoidectomy and resection of sigmoid sinus, with or without decompression/mobilization of auditory canal or petrous carotid artery.
Modifiers may be applicable. Modifier 51 is used when multiple procedures are performed by the same surgeon.
Medical necessity must be established by documenting the underlying condition requiring surgical intervention in the middle cranial fossa and why the infratemporal post-auricular approach was necessary.
The surgeon is responsible for selecting and performing the appropriate surgical approach, including mastoidectomy, sigmoid sinus resection, and decompression/mobilization of the auditory canal/petrous carotid artery as needed. They ensure access to the targeted lesion in the middle cranial fossa while minimizing risks to surrounding structures.
In simple words: The surgeon accesses the area at the base of the skull behind the ear, sometimes going below the temple area as well. This approach might involve removing part of the bony prominence behind the ear, rerouting a large vein, and adjusting the ear canal or a major artery in the area to get a better view and access to the problem area.
This procedure involves accessing the middle cranial fossa through an infratemporal (below the temporal fossa) and post-auricular (behind the ear) approach. It may also include a mastoidectomy (removal of the mastoid bone), resection of the sigmoid sinus (a major vein), and decompression or mobilization of the auditory canal or petrous carotid artery. The specific approach is chosen based on the location and extent of the lesion being addressed.
Example 1: A patient presents with a cholesteatoma extending into the middle cranial fossa. Code 61591 is used for the surgical approach to remove the cholesteatoma., A patient requires surgery for a meningioma located in the petrous apex. The surgeon performs an infratemporal post-auricular approach. This is reported with 61591., A patient with a glomus jugulare tumor involving the middle cranial fossa undergoes surgery via an infratemporal post-auricular approach. Code 61591 is reported.
Documentation should clearly specify the surgical approach used, including any mastoidectomy, sigmoid sinus resection, and decompression/mobilization of the auditory canal or petrous carotid artery. The location and nature of the lesion requiring the approach must be documented as well. The operative report should detail the extent of the procedure and any complications encountered.
- Revenue Code: P1G - MAJOR PROCEDURE - OTHER
- Specialties:Neurosurgery, Otolaryngology, and potentially other specialties like Plastic Surgery when complex reconstruction is needed.
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center