2025 CPT code 61501

Surgical removal of infected skull bone (craniectomy) due to osteomyelitis.

Follow current AMA CPT coding guidelines for surgical procedures.Appropriate documentation is crucial for accurate coding.Consult the AMA CPT manual for the most up-to-date information.

Modifiers may be applicable depending on the circumstances. For instance, modifier 51 (multiple procedures) could be used if other procedures were performed during the same surgical session. Modifier 22 (increased procedural services) might be applicable if the procedure was significantly more extensive than usual.Refer to the CPT manual for modifier guidelines.

Medical necessity for craniectomy to treat osteomyelitis is established by documentation of a chronic bone infection that is unresponsive to conservative management (e.g., antibiotics). The infection should pose a threat to patient health, such as causing pain, neurological deficits, or systemic effects.Imaging must show evidence of bone destruction, and the surgical removal should be deemed necessary by the surgeon to control the infection.

The neurosurgeon or a qualified surgeon is responsible for performing the craniectomy, including incision, bone removal, potential reconstruction, wound closure, and hemostasis. Pre-operative assessment, post-operative monitoring, and management of potential complications are also the responsibility of the surgeon.

IMPORTANT For injection procedures related to cerebral angiography, refer to codes 36100-36218. For ventriculography, use codes 61026, 61120. For pneumoencephalography, use code 61055. Code 61500 is used for excision of bone tumors or lesions.For excision of brain tumors, see codes 61510-61512 and 61518-61521.

In simple words: The doctor surgically removes the infected part of the skull bone.This is done to treat a bone infection called osteomyelitis.The doctor may replace the removed bone with a graft or other material to repair the skull.

This procedure involves the surgical removal of a portion of the skull bone affected by osteomyelitis (bone infection).The surgeon makes an incision, retracts the scalp, removes the infected bone, and may reconstruct the skull defect using a bone graft or other material.Wound closure and hemostasis are performed.This code is specifically for craniectomy performed to address osteomyelitis.

Example 1: A 55-year-old male presents with chronic osteomyelitis of the skull following a head injury several months prior.The infection is localized to a specific area of the parietal bone.A craniectomy is performed to remove the infected bone, and a bone graft is used for reconstruction., A 70-year-old female with a history of diabetes develops osteomyelitis of the temporal bone after a craniotomy for brain tumor resection.The infection is confirmed by culture and imaging studies. A craniectomy is performed to remove the infected bone and debride the area.A cranioplasty is performed at a later date after successful control of infection., A 30-year-old male sustained a compound skull fracture in a motor vehicle accident.Despite antibiotic treatment, he develops chronic osteomyelitis of the frontal bone. Surgical debridement and craniectomy are performed to remove infected and necrotic bone.Reconstruction is deferred until the infection is completely resolved.

* Detailed history and physical examination, including documentation of the site and extent of osteomyelitis.* Pre-operative imaging studies (e.g., CT scan, MRI) demonstrating the extent of bone involvement.* Intraoperative findings documenting the amount of bone removed.* Pathological findings confirming the presence of osteomyelitis.* Post-operative imaging (if applicable) to assess healing and reconstruction success.* Complete operative report detailing the procedure performed.

** Accurate coding requires comprehensive documentation supporting the medical necessity of the procedure and the specific details of the surgical intervention.Always refer to the most current CPT manual and payer guidelines for coding instructions and potential limitations.

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