CPT code 61514 is for a surgical procedure involving the removal of a brain abscess in the upper part of the brain through a craniotomy.
CPT code 61514 is used to describe a surgical procedure known as a craniectomy, trephination, or bone flap craniotomy, specifically performed for the excision of a brain abscess located in the supratentorial region of the brain. This procedure involves the removal of a portion of the skull to access and remove an abscess, which is a collection of pus caused by an infection, situated above the tentorium cerebelli, a membrane that separates the cerebrum from the cerebellum. This code is crucial for healthcare providers to accurately document and bill for the surgical intervention required to treat this serious condition.
For CPT code 61514, 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 factors such as increased complexity or time.
2. Modifier 51 (Multiple Procedures): Apply this modifier 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): This modifier is used to indicate that the procedure is 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): If two surgeons are required to perform the procedure due to its complexity, this modifier should be used to indicate that both surgeons are primary and are working together.
5. Modifier 66 (Surgical Team): Use this modifier when the procedure requires a surgical team due to its complexity, indicating that multiple professionals are involved in the surgery.
6. Modifier 78 (Unplanned Return to the Operating/Procedure Room): This modifier is applicable if the patient needs to return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Apply this modifier if a procedure is performed by the same physician during the postoperative period of another procedure, but it is unrelated to the original procedure.
8. Modifier 80 (Assistant Surgeon): Use this modifier when an assistant surgeon is required to help with the procedure.
9. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when an assistant surgeon is required on a limited basis.
10. Modifier 82 (Assistant Surgeon when Qualified Resident Surgeon Not Available): Apply this modifier 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 refer to the latest coding guidelines and payer-specific policies when applying modifiers.
CPT code 61514, which involves a specific neurosurgical procedure, is reimbursed by Medicare, provided that it meets the necessary medical necessity criteria and documentation requirements. The reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for physician services covered by Medicare. Additionally, the specific reimbursement and coverage details may vary slightly depending on the region, as they are also subject to the policies of the local Medicare Administrative Contractor (MAC). It is essential for healthcare providers to verify the coverage specifics with their respective MAC to ensure compliance and accurate billing.
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