CPT code 61140 is for a procedure involving creating a hole in the skull to obtain a tissue sample from the brain or an intracranial lesion.
CPT code 61140 is used to describe a surgical procedure where a burr hole or trephine is created in the skull to obtain a biopsy of a brain or intracranial lesion. This code is specifically for cases where the primary purpose of the procedure is to collect a tissue sample for diagnostic purposes, allowing healthcare providers to analyze the sample and determine the nature of the lesion, which could be critical for diagnosing conditions such as tumors or other abnormalities within the brain.
For CPT code 61140, 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: This modifier is used 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: Apply this modifier when the procedure is distinct or independent from other services performed on the same day. It is used to indicate that the procedure is not normally reported together but is appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure. Each surgeon should report their distinct operative work.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Use this modifier if the procedure needs to be repeated by the same provider on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when a procedure is repeated by a different provider on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Use this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure is performed by the same physician during the postoperative period of another procedure, but it is unrelated to the original procedure.
These modifiers should be used appropriately based on the specific clinical scenario and documentation should support their use to ensure accurate billing and reimbursement.
CPT code 61140 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 and the associated payment rates.
However, the actual reimbursement for CPT code 61140 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 local coverage determinations, which can influence whether and how much Medicare reimburses for this specific procedure.
Healthcare providers should consult their local MAC for detailed information on coverage and reimbursement rates for CPT code 61140.
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