CPT code 61690 is used for a surgical procedure involving the treatment of a simple dural intracranial arteriovenous malformation.
CPT code 61690 is used to describe a surgical procedure involving the treatment of an intracranial arteriovenous malformation (AVM) that is located in the dura mater, which is the outermost layer of the meninges surrounding the brain and spinal cord. This code specifically refers to a "simple" procedure, indicating that the AVM is treated without the need for complex or extensive surgical techniques. This type of surgery is typically performed to prevent potential complications such as bleeding or neurological deficits that can arise from untreated AVMs.
For CPT code 61690, which pertains to the surgery of intracranial arteriovenous malformation, dural, simple, 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 difficulty of the surgery.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was carried out.
3. Modifier 52 - Reduced Services: This 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 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This is used when the same procedure is repeated by the same provider.
9. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This indicates that a procedure was repeated by a different provider.
10. 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 needs to return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement. It's important to use them correctly to avoid claim denials or delays.
The CPT code 61690 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 reimbursement process involves the Medicare Administrative Contractor (MAC) for your specific region, which is responsible for processing claims and ensuring compliance with Medicare policies.
It is important for healthcare providers to verify the specific reimbursement details and any potential local coverage determinations (LCDs) that may apply to CPT code 61690 through their MAC.
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