CPT code 61692 is for a complex surgery involving the treatment of an intracranial arteriovenous malformation in the dural area.
CPT code 61692 is used to describe a surgical procedure involving the treatment of an intracranial arteriovenous malformation (AVM) that is dural and complex in nature. This code is specifically for surgeries that address abnormal connections between arteries and veins in the brain's dura mater, which is the outermost layer covering the brain. The complexity of the procedure typically involves intricate surgical techniques to safely manage and correct these abnormal vascular formations, which can pose significant risks if left untreated. This code is essential for healthcare providers to accurately document and bill for the specialized surgical intervention required for such complex cases.
For CPT code 61692, which pertains to the surgery of intracranial arteriovenous malformation, dural, complex, 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 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 particularly relevant if the procedure is not typically reported together with other procedures.
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): If the procedure requires a team of surgeons due to its complexity, this modifier is used to reflect the involvement of multiple professionals.
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 80 (Assistant Surgeon): If an assistant surgeon is required to help with the procedure, this modifier indicates their involvement.
8. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This is used when an assistant surgeon is necessary, and a qualified resident is not available to assist.
Each of these modifiers serves a specific purpose and should be used in accordance with the specific circumstances of the procedure to ensure accurate billing and reimbursement.
The CPT code 61692 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies set forth by the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a comprehensive listing of fees used to reimburse physicians and other healthcare providers on a fee-for-service basis. Each MAC may have specific guidelines and coverage determinations that affect whether CPT code 61692 is reimbursed.
Therefore, it is crucial for healthcare providers to consult the MPFS and their local MAC's policies to confirm the reimbursement status and any specific requirements or documentation needed for this particular code.
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