CPT code 63280 is for a surgical procedure involving the removal of a spinal tumor located in the cervical region, specifically within the dura but outside the spinal cord.
CPT code 63280 is used to describe a surgical procedure known as a laminectomy, which is performed for the biopsy or excision of an intraspinal neoplasm located in the cervical region of the spine. This specific code indicates that the neoplasm is intradural, meaning it is located within the dura mater, the outermost membrane covering the spinal cord, but is extramedullary, meaning it is outside the spinal cord itself. This procedure involves removing a portion of the vertebral bone called the lamina to access and remove or biopsy the tumor, which can help in diagnosing or treating conditions related to spinal tumors.
For CPT code 63280, 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 multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was performed.
3. 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 reported together.
4. Modifier 62 (Two Surgeons): If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that each surgeon performed a distinct part of the procedure.
5. Modifier 66 (Surgical Team): Use this modifier when the procedure requires a surgical team due to its complexity.
6. Modifier 76 (Repeat Procedure by Same Physician): If the same procedure is repeated by the same physician, this modifier is used to indicate the repeat service.
7. Modifier 77 (Repeat Procedure by Another Physician): If the procedure is repeated by a different physician, this modifier is used.
8. Modifier 78 (Unplanned Return to the Operating/Procedure Room): If the patient needs to return to the operating room for a related procedure during the postoperative period, this modifier is applicable.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 (Assistant Surgeon): If an assistant surgeon is necessary for the procedure, this modifier indicates their involvement.
11. Modifier 81 (Minimum Assistant Surgeon): Use this modifier if a minimum assistant surgeon is required for the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used when an assistant surgeon is necessary, and a qualified resident is not available.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used when a non-physician provider assists in the surgery.
Each modifier should be used in accordance with payer guidelines and documentation should support the use of any modifier to ensure proper reimbursement and compliance.
CPT code 63280 is reimbursed by Medicare, but the reimbursement is subject to several factors. The Medicare Physician Fee Schedule (MPFS) provides the framework for determining the payment rates for services covered under Medicare Part B, including surgical procedures like those represented by CPT code 63280. The reimbursement amount 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 specific payment rates within their jurisdiction, which means that while CPT code 63280 is generally covered, the exact reimbursement may differ across regions. Healthcare providers should consult the MPFS and their local MAC for precise reimbursement details.
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