CPT code 61458 is for a craniectomy, suboccipital, used to explore or relieve pressure on cranial nerves.
CPT code 61458 is used to describe a surgical procedure known as a craniectomy, specifically performed in the suboccipital region of the skull. This procedure involves the removal of a portion of the skull to allow for the exploration or decompression of cranial nerves. It is typically undertaken to relieve pressure on these nerves, which may be caused by conditions such as tumors, vascular malformations, or other abnormalities that affect the cranial nerves' function. The goal of this procedure is to alleviate symptoms and prevent further neurological damage by providing more space for the affected nerves.
For CPT code 61458, 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 unusual procedural complications or patient conditions.
2. Modifier 51 (Multiple Procedures): Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that the procedure is part of a series of procedures.
3. Modifier 52 (Reduced Services): Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 62 (Two Surgeons): If two surgeons are required to perform the procedure, this modifier indicates that each surgeon is performing a distinct part of the procedure.
6. Modifier 80 (Assistant Surgeon): Use this modifier when an assistant surgeon is required to help perform the procedure.
7. Modifier 81 (Minimum Assistant Surgeon): This is used when an assistant surgeon is required for a minimal portion of the procedure.
8. Modifier 82 (Assistant Surgeon when Qualified Resident Surgeon Not Available): Use this when an assistant surgeon is necessary 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. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
The CPT code 61458 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies of the local Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive listing of fees used to reimburse physicians and other healthcare providers on a fee-for-service basis. However, the final decision on whether CPT code 61458 is reimbursed, and at what rate, can vary based on the specific guidelines and coverage determinations set forth by the MAC in your region.
It is essential for healthcare providers to verify the specific reimbursement details with their local MAC to ensure compliance and proper billing practices.
Discover the power of MD Clarity's RevFind software to ensure you're receiving every dollar you're owed. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 61458, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and secure your financial health.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
