2025 CPT code 61550
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Craniectomy for craniosynostosis affecting a single cranial suture.
Modifiers 22 (Increased Procedural Services), 51 (Multiple Procedures), 59 (Distinct Procedural Service), and others may apply depending on the specifics of the case.
Medical necessity is established through clinical findings demonstrating the presence of craniosynostosis, such as abnormal head shape, premature closure of cranial sutures, and potential intracranial pressure.The surgery aims to prevent the complications associated with craniosynostosis, including impaired brain growth, vision problems, and developmental delays.Appropriate documentation supporting the diagnosis and the need for surgical intervention is essential for establishing medical necessity.
The neurosurgeon or pediatric neurosurgeon is primarily responsible for the surgical procedure. This includes patient assessment, surgical planning, incision, bone removal and reshaping, and wound closure. Anesthesia is administered by a qualified anesthesiologist or certified registered nurse anesthetist. Post-operative care and follow-up are crucial parts of the clinical responsibility, often shared amongst the surgical team and other specialists.
In simple words: The doctor makes a cut in the skull to fix a problem where the skull bones joined too early.They remove and reshape a piece of skull bone so the head can grow normally. Then they stitch up the scalp.
This procedure involves a craniectomy to address craniosynostosis affecting a single cranial suture.The surgeon makes an incision into the skull over the affected suture, a fibrous tissue connecting skull bones.A portion of the skull bone is then removed and reshaped to allow for normal skull growth. The scalp is sutured, and a sterile dressing is applied.
Example 1: A 6-month-old infant presents with sagittal craniosynostosis, showing a long, narrow head shape.A craniectomy is performed to reshape the skull and allow for normal brain growth., A 1-year-old child is diagnosed with unilateral coronal craniosynostosis.The procedure involves removing a portion of the skull bone on one side of the head to correct the asymmetry and allow for symmetrical growth., A 2-year-old with metopic craniosynostosis displays a pointed forehead. Surgical correction is done to alleviate pressure on the brain and improve the aesthetic appearance of the forehead. The procedure involves removing the fused bone in the metopic suture and reshaping the frontal bone.
Pre-operative: Detailed patient history, including family history of craniosynostosis; physical exam findings; imaging studies (CT scan, MRI); informed consent. Intra-operative: Detailed operative notes, including the suture involved; bone removed; technique used; any complications; blood loss; and specimens collected. Post-operative:Post-operative imaging, discharge summary and instructions for post-operative care and follow-up.
** The code 61550 is for single suture craniosynostosis. For multiple sutures, code 61552 should be used.Always refer to the current CPT manual for the most up-to-date coding guidelines and instructions.Proper documentation is crucial for accurate coding and reimbursement.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- Payment Status: Active
- Specialties:Neurosurgery, Pediatric Neurosurgery, Plastic Surgery (Craniofacial)
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center