I am grateful for help with coding this surgery. This was performed by only one ENT surgeon. He has indicated CPT code 61605 for skull base surgery of the infratemporal fossa. It reads to me like it is primarily about excising the maxillary sinus papilloma along with areas where it eroded, I don't see that the tumor itself was actually in the infratemporal fossa. Possible codes instead of 61605: 21049 , 31299 compared to 31255, 31267, 30130, 31030. Here is the documentation. I apologize for the length of the text. If it makes a difference, the patient was a 23-hour same day stay.
Procedure: Right endoscopic medial maxillectomy and Caldwell Luc approach for resection of recurrent inverting papilloma and resection of neoplastic process involving the infratemporal fossa (CPT code 61605)
Description of procedure: Using a 0 degree endoscope, the right nasal cavity was inspected. The inferior turbinate and middle turbinate were infiltrated with 1% lidocaine with 1: 100,000 epinephrine. There was a large tumor emanating from the patient's previous maxillary antrostomy. This was debulked with Blakesley forceps and sent for permanent pathology. Further removal was obtained with a microdebrider. The right inferior turbinate was removed using turbinate scissors and a through cut. Once it was removed it was sent for permanent pathology. The stump of the inferior turbinate was cauterized with suction monopolar cautery. The remaining medial maxillary sinus wall was removed using an antrum punch and backbiter. At this point I began dissecting out the posterior maxillary sinus wall until we reached the point of bony erosion. A periosteal elevator was used to strip the mucosa off the posterior maxillary sinus wall. We then made an incision and the right gingivobuccal sulcus with monopolar cautery and then dissected in a subperiosteal plane along the anterior face of the maxillary sinus. V2 was found and preserved. Using a chisel, Kerrison rongeurs, and a drill, we opened up the anterior maxillary sinus wall to gain access to the tumor. We then used a combined open and endoscopic approach to remove the mucosa of the entire maxillary sinus and an anterior to posterior fashion using a periosteal elevator, Blakesley forceps, and the microdebrider. We then completely dissected out the area of bony erosion on the posterior lateral maxillary sinus wall. A portion of the surrounding bone was removed with a Kerrison rongeur. We then drilled down the bone along the posterior maxillary sinus wall. Finally, a portion of the infratemporal fossa including fascia and adipose tissue was dissected out with suction and a periosteal elevator. The internal maxillary artery was preserved. Small bleeders were controlled with clips and suction monopolar cautery. Once we freed up our were infected pleural fossa specimen, was passed off for permanent pathology. The maxillary sinus was copiously irrigated out with normal saline. Floseal was placed in to the maxillary sinus as well as a piece of NasoPore. The Caldwell Luc incision was closed using horizontal mattress Polysorb sutures. The patient stomach was suctioned out with an orogastric tube.
Procedure: Right endoscopic medial maxillectomy and Caldwell Luc approach for resection of recurrent inverting papilloma and resection of neoplastic process involving the infratemporal fossa (CPT code 61605)
Description of procedure: Using a 0 degree endoscope, the right nasal cavity was inspected. The inferior turbinate and middle turbinate were infiltrated with 1% lidocaine with 1: 100,000 epinephrine. There was a large tumor emanating from the patient's previous maxillary antrostomy. This was debulked with Blakesley forceps and sent for permanent pathology. Further removal was obtained with a microdebrider. The right inferior turbinate was removed using turbinate scissors and a through cut. Once it was removed it was sent for permanent pathology. The stump of the inferior turbinate was cauterized with suction monopolar cautery. The remaining medial maxillary sinus wall was removed using an antrum punch and backbiter. At this point I began dissecting out the posterior maxillary sinus wall until we reached the point of bony erosion. A periosteal elevator was used to strip the mucosa off the posterior maxillary sinus wall. We then made an incision and the right gingivobuccal sulcus with monopolar cautery and then dissected in a subperiosteal plane along the anterior face of the maxillary sinus. V2 was found and preserved. Using a chisel, Kerrison rongeurs, and a drill, we opened up the anterior maxillary sinus wall to gain access to the tumor. We then used a combined open and endoscopic approach to remove the mucosa of the entire maxillary sinus and an anterior to posterior fashion using a periosteal elevator, Blakesley forceps, and the microdebrider. We then completely dissected out the area of bony erosion on the posterior lateral maxillary sinus wall. A portion of the surrounding bone was removed with a Kerrison rongeur. We then drilled down the bone along the posterior maxillary sinus wall. Finally, a portion of the infratemporal fossa including fascia and adipose tissue was dissected out with suction and a periosteal elevator. The internal maxillary artery was preserved. Small bleeders were controlled with clips and suction monopolar cautery. Once we freed up our were infected pleural fossa specimen, was passed off for permanent pathology. The maxillary sinus was copiously irrigated out with normal saline. Floseal was placed in to the maxillary sinus as well as a piece of NasoPore. The Caldwell Luc incision was closed using horizontal mattress Polysorb sutures. The patient stomach was suctioned out with an orogastric tube.