CPT code 61751 is for a procedure involving a stereotactic biopsy or excision of an intracranial lesion using CT or MRI guidance.
CPT code 61751 is used to describe a medical procedure involving a stereotactic biopsy, aspiration, or excision of an intracranial lesion. This procedure is performed using advanced imaging techniques such as computed tomography (CT) and/or magnetic resonance imaging (MRI) to guide the surgeon. The process involves creating one or more burr holes in the skull to access the lesion within the brain. This code is essential for accurately documenting and billing for the use of these precise and minimally invasive techniques in diagnosing or treating brain lesions.
For CPT code 61751, 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 work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the imaging guidance, not the technical component.
3. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion. Documentation should clearly indicate the reason for the reduction.
4. Modifier 53 - Discontinued Procedure: Use this modifier when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
6. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, each surgeon should report their distinct operative work by adding this modifier.
7. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Use this modifier if the same procedure is repeated by the same provider.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when a procedure is repeated by a different provider.
9. 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 is used when a related procedure is performed during the postoperative period of the initial procedure.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Use this when an assistant surgeon is required on a limited basis.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is required, and a qualified resident surgeon is not available.
14. Modifier 99 - Multiple Modifiers: If multiple modifiers are applicable, this modifier indicates that more than four modifiers are being used on a single CPT code.
Each modifier should be used in accordance with the specific circumstances of the procedure and supported by appropriate documentation to ensure accurate billing and reimbursement.
CPT code 61751 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 fees that Medicare uses to reimburse healthcare providers for services rendered. However, the actual reimbursement can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing Medicare claims and may have additional local coverage determinations that affect reimbursement for CPT code 61751. Therefore, it is essential for healthcare providers to consult their specific MAC for detailed information on coverage and reimbursement rates for this code.
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