CPT code 63268 is for a surgical procedure to remove or evacuate a non-cancerous lesion from the sacral area of the spine.
CPT code 63268 is used to describe a surgical procedure known as a laminectomy, specifically performed for the excision or evacuation of an intraspinal lesion that is not a neoplasm (tumor) and is located extradural (outside the dura mater) in the sacral region of the spine. This procedure involves the removal of a portion of the vertebral bone called the lamina to access and remove or evacuate the lesion, which may be causing pain, neurological deficits, or other complications. The sacral region refers to the lower part of the spine, near the pelvis. This code is utilized by healthcare providers to accurately document and bill for this specific type of spinal surgery.
For CPT code 63268, 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 effort or time than typically required.
2. Modifier 50 (Bilateral Procedure): Apply this modifier if the procedure was performed bilaterally during the same operative session.
3. Modifier 51 (Multiple Procedures): Use this when multiple procedures are performed during the same surgical session.
4. 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.
5. Modifier 76 (Repeat Procedure by Same Physician): Use this modifier if the procedure was repeated by the same physician or other qualified healthcare professional.
6. Modifier 77 (Repeat Procedure by Another Physician): Apply this if the procedure was repeated by a different physician or qualified healthcare professional.
7. Modifier 78 (Unplanned Return to the Operating/Procedure Room): Use this when a related procedure is performed during the postoperative period due to complications.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician): This is used when an unrelated procedure is performed by the same physician during the postoperative period.
9. Modifier 80 (Assistant Surgeon): Use this when an assistant surgeon is required for the procedure.
10. Modifier 81 (Minimum Assistant Surgeon): Apply this when a minimum assistant surgeon is required.
11. Modifier 82 (Assistant Surgeon when Qualified Resident Surgeon Not Available): Use this when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
12. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This is used when these professionals assist in the surgery.
Each modifier should be used in accordance with the specific guidelines and payer policies to ensure accurate billing and reimbursement.
The CPT code 63268 is reimbursed by Medicare, but the reimbursement is subject to several factors. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in determining the reimbursement rates for this procedure. The MPFS outlines the payment amounts for various services, including surgical procedures like the one associated with CPT code 63268.
However, it's important to note that the reimbursement can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national Medicare policies and apply them to their specific jurisdiction, which can affect the final reimbursement amount for CPT code 63268. Therefore, healthcare providers should consult their local MAC for precise reimbursement details and ensure compliance with any additional documentation or billing requirements that may apply.
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