CPT code 61543 is for a craniotomy procedure involving the elevation of a bone flap for a partial or subtotal hemispherectomy.
CPT code 61543 is used to describe a surgical procedure known as a craniotomy with the elevation of a bone flap specifically for a partial or subtotal (functional) hemispherectomy. This procedure involves the surgical removal of a portion of the skull to access the brain, allowing the surgeon to perform a hemispherectomy, which is the removal or disconnection of part of one hemisphere of the brain. This type of surgery is typically performed to treat severe epilepsy or other neurological conditions that affect one side of the brain. The goal is to alleviate symptoms by removing or isolating the problematic brain tissue while preserving as much function as possible.
For CPT code 61543, which involves a craniotomy with elevation of bone flap for partial or subtotal (functional) hemispherectomy, 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 increased complexity or time.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that the procedure is one of several performed.
3. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: If the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient, this modifier is applicable.
5. 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.
6. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is used.
7. Modifier 66 - Surgical Team: If the procedure requires a surgical team due to its complexity, this modifier is applicable.
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 modifier is used when a related procedure is performed during the postoperative period of the initial surgery.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used 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.
The CPT code 61543 is reimbursed by Medicare, but the reimbursement is subject to several factors.
The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered under Medicare Part B, including surgical procedures like those represented by CPT code 61543.
However, the actual reimbursement 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 a particular service is reimbursed.
Therefore, while CPT code 61543 is generally reimbursable under Medicare, healthcare providers should consult the MPFS and their specific MAC for precise reimbursement details.
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