CPT code 63275 is for a surgical procedure involving the removal of a spinal tumor located outside the dura in the cervical region.
CPT code 63275 is used to describe a surgical procedure known as a laminectomy, which is performed to biopsy or excise an intraspinal neoplasm located in the extradural space of the cervical spine. This code specifically pertains to the removal or sampling of abnormal tissue or tumors that are situated outside the dura mater, the outermost membrane covering the spinal cord, in the neck region. The procedure involves removing a portion of the vertebral bone called the lamina to access the spinal canal and address the neoplasm.
For CPT code 63275, 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 50 (Bilateral Procedure): If the procedure is performed bilaterally, this modifier should be appended to indicate that the procedure was performed on both sides of the body.
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 is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. Modifier 62 (Two Surgeons): If two surgeons are required to perform the procedure due to its complexity, this modifier should be used to indicate that each surgeon performed a distinct part of the procedure.
6. Modifier 76 (Repeat Procedure by Same Physician): Use this modifier if the same procedure is repeated by the same physician on the same day.
7. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when the same procedure is repeated by a different physician on the same day.
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): Use this modifier when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
10. Modifier 80 (Assistant Surgeon): If an assistant surgeon is required for the procedure, this modifier should be used to indicate their involvement.
11. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when an assistant surgeon is required for a minimal portion of the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Use this modifier when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
13. Modifier 99 (Multiple Modifiers): If multiple modifiers are applicable, this modifier indicates that more than one modifier is being used.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement. Always refer to the latest coding guidelines and payer-specific policies when applying modifiers.
The CPT code 63275 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 associated with CPT code 63275. However, the actual reimbursement can vary based on geographic location and other factors determined by the Medicare Administrative Contractor (MAC) responsible for the specific region where the service is provided.
Each MAC has the authority to interpret national Medicare policies and set local coverage determinations (LCDs) that may affect reimbursement. Therefore, healthcare providers should consult the MPFS and their respective MAC to understand the specific reimbursement details for CPT code 63275.
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