CPT code 61860 is for a surgical procedure involving the removal or opening of the skull to implant electrodes for brain stimulation.
CPT code 61860 is used to describe a surgical procedure involving either a craniectomy or craniotomy for the purpose of implanting neurostimulator electrodes in the cerebral cortex. This procedure is typically performed to manage neurological conditions by delivering electrical stimulation to specific areas of the brain. The goal is often to alleviate symptoms associated with disorders such as epilepsy or chronic pain. The code is essential for healthcare providers to accurately document and bill for this complex surgical intervention, ensuring proper reimbursement and tracking of the procedure within the healthcare system.
For the CPT code 61860, which involves a craniectomy or craniotomy for the implantation of neurostimulator electrodes, cerebral, cortical, 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 complications or additional work that was not anticipated.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was performed.
3. Modifier 52 - Reduced Services: This modifier is applied when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. 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.
5. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is used.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by another physician or qualified healthcare professional.
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 is used when a related procedure is performed during the postoperative period of the initial procedure.
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 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 is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier 99 - Multiple Modifiers: This is used when two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used according to the specific circumstances of the procedure to ensure accurate billing and reimbursement.
The CPT code 61860 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines. The Medicare Physician Fee Schedule (MPFS) provides the framework for determining the reimbursement rates for services covered under Medicare Part B, including surgical procedures like those represented by CPT code 61860.
However, it's important to note that the reimbursement for this code can vary based on geographic location and other factors. Medicare Administrative Contractors (MACs) play a crucial role in this process, as they are responsible for processing claims and determining the local coverage and payment policies. Each MAC may have specific guidelines or requirements that healthcare providers must adhere to in order to receive reimbursement for CPT code 61860.
Therefore, it is advisable for healthcare providers to consult with their respective MAC to understand the specific reimbursement criteria and ensure compliance with any local coverage determinations.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 61860, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can optimize your revenue cycle and enhance your financial outcomes.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
