CPT code 63285 is for a surgical procedure involving the removal of a spinal tumor located within the cervical region of the spinal cord.
CPT code 63285 is used to describe a surgical procedure known as a laminectomy, which is performed for the biopsy or excision of an intraspinal neoplasm located within the cervical region of the spine. This specific code indicates that the neoplasm is intradural (inside the dura mater, the outer membrane covering the spinal cord) and intramedullary (within the spinal cord itself). The procedure involves removing a portion of the vertebral bone called the lamina to access and remove or biopsy the tumor. This code is critical for healthcare providers to accurately document and bill for the complex surgical intervention required to address such spinal tumors.
For CPT code 63285, 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 work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 - Multiple Procedures: Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several 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 is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier should be used. Each surgeon should report their distinct operative work.
5. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to assist with the procedure. It indicates that another surgeon provided assistance during the operation.
6. Modifier 81 - Minimum Assistant Surgeon: Use this modifier when a minimum assistant surgeon is required for the procedure, indicating limited assistance was provided.
7. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement. Always ensure that documentation supports the use of any modifier applied.
CPT code 63285 is reimbursed by Medicare, provided that it meets the necessary coverage criteria and is deemed medically necessary. The reimbursement for this procedure is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B.
Additionally, the specific reimbursement details and any local coverage determinations are managed by the Medicare Administrative Contractor (MAC) for the provider's region. It is essential for healthcare providers to verify the coverage and reimbursement specifics with their respective MAC to ensure compliance and accurate billing.
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