CPT code 63287 is for a surgical procedure involving the removal of a spinal tumor located within the thoracolumbar region.
CPT code 63287 is used to describe a surgical procedure known as a laminectomy, which is performed for the biopsy or excision of an intraspinal neoplasm. This specific code indicates that the procedure involves accessing the intradural, intramedullary space within the thoracolumbar region of the spine. In simpler terms, it refers to the removal or sampling of a tumor located inside the spinal cord's protective layers, specifically in the middle section of the spine that includes the thoracic and lumbar areas. This procedure is typically performed by a neurosurgeon and is crucial for diagnosing or treating spinal tumors.
For CPT code 63287, the following modifiers may be applicable depending on the specific circumstances of the procedure:
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 increased complexity or difficulty of the case.
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 is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is used to indicate the collaborative effort.
5. Modifier 66 - Surgical Team: This modifier is applicable when a complex procedure requires the services of a surgical team.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This is used when the same procedure is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This indicates that a procedure was repeated by a different provider.
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 is used when a 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: This modifier is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This indicates that an assistant surgeon was necessary for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: 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): This is used when an assistant surgeon is necessary, and a qualified resident is not available.
13. Modifier 99 - Multiple Modifiers: This is used when two or more modifiers are necessary to describe the service provided.
Each modifier should be applied based on the specific circumstances of the procedure and the documentation provided. Proper use of modifiers ensures accurate billing and reimbursement.
CPT code 63287 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 63287. The reimbursement amount can vary based on geographic location and other factors, as determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a specific region. It is essential for healthcare providers to verify the specific reimbursement details with their local MAC to ensure accurate billing and payment for services rendered under this CPT code.
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