Use of 15740 for Closure Following Pituitary Tumor Excision

Question:

My physician performed a pituitary tumor excision and reported CPT code 62165-62. The ENT surgeon also performs a pedicled flap (15740). The neurosurgeon performs a fat graft for the closure. Can 15740 also be billed for the ENT surgeon, and if so, would a 59 modifier be needed?

Answer:

In skull base cases, when the ENT harvests a nasoseptal flap to repair or prevent a cerebrospinal fluid (CSF) leak during an endoscopic pituitary excision, this work is considered part of the procedure. According to CPT Assistant (December 2017, page 14), closure of a CSF leak—including the use of a nasoseptal flap—is included in the work described by 62165 and should not be separately reported. Therefore, 15740 would not be separately billable in this scenario, and modifier 59 would not apply.

*This response is based on the best information available as of 12/18/25.