CPT code 61345 is a medical code used to describe the procedure of other cranial decompression in the posterior fossa.
CPT code 61345 is used to describe a surgical procedure known as "Other cranial decompression, posterior fossa." This procedure involves relieving pressure on the brain by removing a portion of the skull in the posterior fossa region, which is located at the back of the skull near the brainstem and cerebellum. This type of decompression is typically performed to treat conditions that cause increased intracranial pressure, such as tumors, hemorrhages, or congenital abnormalities, and aims to alleviate symptoms and prevent further neurological damage.
For CPT code 61345, which pertains to other cranial decompression in the posterior fossa, 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 carried out.
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: If the procedure requires the expertise of a surgical team, this modifier is used to denote the involvement of multiple professionals working together.
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 modifier is used when the same procedure is 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 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: 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 is used when an assistant surgeon is required to help with the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This indicates that a minimal assistant surgeon was necessary for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is required because a qualified resident surgeon is not available.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review the specific guidelines and payer policies to determine the appropriate use of each modifier.
CPT code 61345 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the local Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services and procedures covered by Medicare, along with their respective reimbursement rates. However, the final decision on whether a specific CPT code like 61345 is reimbursed can also depend on the local MAC, which may have additional guidelines or requirements for coverage.
Therefore, healthcare providers should verify the reimbursement status of CPT code 61345 by consulting the MPFS and their respective MAC's policies to ensure compliance and accurate billing.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 61345. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
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