CPT code 63273 is for a laminectomy procedure to remove a non-cancerous lesion within the sacral spine's protective covering.
CPT code 63273 is used to describe a surgical procedure known as a laminectomy, specifically for the excision of an intraspinal lesion that is not a neoplasm, located intradurally in the sacral region. This procedure involves the removal of a portion of the vertebral bone called the lamina to access and remove the lesion within the spinal canal. The focus of this code is on addressing lesions that are not cancerous (non-neoplastic) and are situated within the dura mater, the protective membrane covering the spinal cord, in the sacral area of the spine. This code is essential for accurately documenting and billing for this specific type of spinal surgery.
For CPT code 63273, 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 intensity, time, technical difficulty, severity of the patient's condition, or physical and mental effort required.
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 on the same day.
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 76 (Repeat Procedure by Same Physician): Use this modifier if the same procedure is repeated by the same physician on the same day.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is applicable if the procedure is repeated by a different physician on the same day.
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): This is used when a patient returns 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): Use this modifier when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
8. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required for the procedure.
9. Modifier 81 (Minimum Assistant Surgeon): Apply this modifier when a minimum assistant surgeon is required for the procedure.
10. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Use this modifier when an assistant surgeon is required, and a qualified resident surgeon is not available.
11. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used when a non-physician provider assists in the surgery.
Each modifier should be used in accordance with the specific guidelines and payer policies to ensure accurate billing and reimbursement.
The CPT code 63273 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and healthcare providers for services rendered. However, the reimbursement for CPT code 63273 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for interpreting national policies and setting local coverage determinations, which can influence whether and how much Medicare reimburses for this particular procedure. Therefore, it is essential for healthcare providers to consult their specific MAC for detailed information regarding coverage and reimbursement rates for CPT code 63273.
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