CPT code 63283 is for a surgical procedure involving the removal or biopsy of a tumor within the spinal canal at the sacral level.
CPT code 63283 is used to describe a surgical procedure known as a laminectomy, specifically performed for the biopsy or excision of an intraspinal neoplasm located within the intradural space of the sacral region. This procedure involves the removal of a portion of the vertebral bone called the lamina to access and remove or biopsy a tumor or abnormal growth within the spinal canal, specifically in the sacral area, which is the lower part of the spine. This code is crucial for healthcare providers to accurately document and bill for the surgical intervention required to address spinal tumors in this specific location.
For CPT code 63283, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 (Increased Procedural Services): 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 or time.
2. Modifier 50 (Bilateral Procedure): If the procedure is performed bilaterally, this modifier indicates that the procedure was performed on both sides of the body.
3. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This helps in identifying that more than one procedure was conducted.
4. Modifier 52 (Reduced Services): Used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 62 (Two Surgeons): If two surgeons are required to perform the procedure, each performing distinct parts, this modifier is used to indicate the collaborative effort.
7. Modifier 66 (Surgical Team): Applied when a complex procedure requires a surgical team, indicating that multiple professionals are involved in the surgery.
8. Modifier 76 (Repeat Procedure by Same Physician): Used when the same procedure is repeated by the same physician on the same day.
9. Modifier 77 (Repeat Procedure by Another Physician): Indicates that the procedure was repeated by a different physician on the same day.
10. Modifier 78 (Unplanned Return to the Operating/Procedure Room): Used when a patient returns to the operating room for a related procedure during the postoperative period.
11. Modifier 79 (Unrelated Procedure or Service by the Same Physician): Indicates that an unrelated procedure was performed by the same physician during the postoperative period.
12. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required for the procedure.
13. Modifier 81 (Minimum Assistant Surgeon): Indicates that a minimum assistant surgeon was required for the procedure.
14. Modifier 82 (Assistant Surgeon when Qualified Resident Surgeon Not Available): Used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
15. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Indicates that a non-physician practitioner assisted in the surgery.
These modifiers should be applied based on the specific details and circumstances of the procedure to ensure accurate billing and reimbursement.
The CPT code 63283 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 services covered by Medicare, along with the payment rates for each service. However, the actual reimbursement can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). MACs are responsible for processing Medicare claims and have the authority to interpret national policies to fit local needs, which can influence the reimbursement process for CPT code 63283. Healthcare providers should consult their local MAC for detailed information on coverage and reimbursement rates for this specific procedure.
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