CPT code 61120 is for creating burr holes in the skull to access the ventricles, often for injecting substances like gas or contrast media.
CPT code 61120 is a medical billing code used to describe the procedure of creating one or more burr holes in the skull to access the brain's ventricles. This procedure is typically performed to allow for the injection of substances such as gas, contrast media, dye, or radioactive material. These injections are often used for diagnostic purposes, such as imaging studies, or for therapeutic interventions. The creation of burr holes is a critical step in neurosurgical procedures, providing a pathway to the brain's ventricular system.
For CPT code 61120, 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 complications or unusual circumstances during the procedure.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier should be used to indicate that it was a bilateral procedure.
3. Modifier 51 - Multiple Procedures: Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was carried out.
4. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. 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.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician repeats the procedure on the same day, this modifier should be used.
7. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if a different physician repeats the procedure 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 applicable 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 the procedure is unrelated to the original procedure and occurs during the postoperative period.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be used.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier when a minimum assistant surgeon is required.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
13. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the service, this modifier indicates that multiple modifiers are being used.
Each modifier serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association and payer-specific policies. Proper use of modifiers ensures accurate billing and reimbursement for the services provided.
The CPT code 61120 is reimbursed by Medicare, provided that it meets the necessary coverage criteria and is deemed medically necessary. Reimbursement for this code 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 and coverage details may vary depending on the region, as they are also influenced by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to make determinations regarding the medical necessity and coverage of services, including those billed under CPT code 61120, within their jurisdiction.
Therefore, healthcare providers should consult the MPFS and their respective MAC for precise reimbursement information and any additional requirements that may apply.
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