CPT CODES

CPT Code 63272

CPT code 63272 is for a lumbar laminectomy to remove an intraspinal lesion that is not a tumor, performed within the spinal canal.

Table of Contents
What is CPT Code 63272
Does CPT 63272 Need a Modifier?
CPT Code 63272 Medicare Reimbursement
Are You Being Underpaid for 63272 CPT Code?
Accelerate your revenue cycle

Boost patient experience and your bottom line by automating patient cost estimates, payer underpayment detection, and contract optimization in one place.

Get a Demo

What is CPT Code 63272

CPT code 63272 is used to describe a surgical procedure known as a laminectomy, specifically performed to excise an intraspinal lesion that is not a neoplasm, located within the intradural space of the lumbar region. This procedure involves the removal of a portion of the vertebral bone called the lamina to access and remove the lesion, which is situated inside the dura mater, the protective membrane covering the spinal cord. This code is crucial for accurately documenting and billing for this specific type of spinal surgery, ensuring that healthcare providers are reimbursed appropriately for their services.

Does CPT 63272 Need a Modifier?

For CPT code 63272, which involves a laminectomy for excision of an intraspinal lesion other than a neoplasm, intradural, in the lumbar region, the following modifiers may be applicable:

1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity of the lesion or anatomical variations.

2. Modifier 50 - Bilateral Procedure: If the procedure is performed bilaterally, this modifier indicates that the procedure was performed on both sides of the lumbar region.

3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was performed.

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. It may be necessary if the laminectomy is performed in conjunction with other procedures that are not typically performed together.

5. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that each surgeon is responsible for a distinct part of the surgery.

6. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure needs to be repeated by the same physician, this modifier is used to indicate the repetition.

7. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier is used to indicate that the repeat procedure was necessary.

8. 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 used if the patient needs to return to the operating room for a related procedure during the postoperative period.

9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If an unrelated procedure is performed by the same physician during the postoperative period, this modifier is used to indicate that the procedures are not related.

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 influence the use of modifiers.

CPT Code 63272 Medicare Reimbursement

CPT code 63272 is reimbursed by Medicare, but the reimbursement is subject to several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered under Medicare Part B, including surgical procedures like those represented by CPT code 63272. The reimbursement amount can vary based on geographic location and other factors determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a specific region. Each MAC may have specific guidelines and policies that affect the reimbursement process, so it's essential for healthcare providers to verify the details with their local MAC to ensure compliance and accurate reimbursement.

Are You Being Underpaid for 63272 CPT Code?

Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 63272, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize your revenue cycle management.

Get paid in full by bringing clarity to your revenue cycle

Get a Demo

Related CPT Codes

Full Page Background