CPT code 61512 is for a surgical procedure involving the removal of a brain tumor called a meningioma from the upper part of the brain.
CPT code 61512 is used to describe a surgical procedure known as a craniectomy, trephination, or bone flap craniotomy specifically performed for the excision of a meningioma located in the supratentorial region of the brain. This code is utilized by healthcare providers to document and bill for the removal of a meningioma, which is a type of tumor that arises from the meninges, the protective membranes covering the brain and spinal cord. The supratentorial region refers to the area of the brain located above the tentorium cerebelli, a structure that separates the cerebrum from the cerebellum. This procedure involves creating an opening in the skull to access and remove the tumor, and the specific coding helps ensure accurate billing and reimbursement for the complex surgical intervention.
For CPT code 61512, which involves a craniectomy, trephination, or bone flap craniotomy for the excision of a supratentorial meningioma, the following modifiers may be applicable:
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 factors such as increased complexity or time.
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 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: If the patient needs to return to the operating room for a related procedure during the postoperative period, this modifier is used.
7. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help with the procedure.
8. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Similar to Modifier 80, but used when 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 to ensure proper use of modifiers.
The CPT code 61512 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 can vary based on the policies of the local Medicare Administrative Contractor (MAC), which administers Medicare claims for a specific geographic region. Healthcare providers should consult the MPFS and their respective MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 61512.
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