CPT code 61544 is for a craniotomy procedure involving the removal or treatment of the choroid plexus using a bone flap.
CPT code 61544 is used to describe a surgical procedure known as a craniotomy with the elevation of a bone flap, specifically performed for the excision or coagulation of the choroid plexus. This procedure involves making an opening in the skull to access the brain, where the surgeon elevates a section of the skull bone (the bone flap) to reach the choroid plexus. The choroid plexus is a network of cells in the brain responsible for producing cerebrospinal fluid. This code is typically used when the procedure is necessary to address conditions such as hydrocephalus or other disorders related to cerebrospinal fluid production or flow.
For CPT code 61544, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly more work than typically required. This could be due to unusual pathology, anatomical variations, or other complicating factors.
2. Modifier 51 (Multiple Procedures): If the craniotomy is performed in conjunction with other procedures during the same surgical session, this modifier indicates that multiple procedures were performed.
3. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It may be necessary if the craniotomy is performed in conjunction with other procedures that are not typically reported together.
4. Modifier 62 (Two Surgeons): If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are actively involved and each is performing a distinct part of the surgery.
5. Modifier 66 (Surgical Team): Use this modifier when the procedure requires a surgical team due to its complexity, indicating that multiple professionals are involved in the surgery.
6. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): This modifier is applicable if the patient needs to return to the operating room for a related procedure during the postoperative period.
7. Modifier 80 (Assistant Surgeon): If an assistant surgeon is necessary for the procedure, this modifier indicates their involvement.
8. Modifier 81 (Minimum Assistant Surgeon): Use this modifier if an assistant surgeon is required on a minimal basis.
9. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used when an assistant surgeon is necessary because a qualified resident is not available.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
The CPT code 61544 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates.
However, the actual reimbursement for CPT code 61544 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting local coverage determinations, which can influence whether and how much Medicare reimburses for this particular procedure.
Therefore, healthcare providers should consult their specific MAC for detailed information on reimbursement rates and any additional requirements for CPT code 61544.
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