CPT code 62287 is for a procedure that removes disc material from the spine using a needle and imaging, often with an endoscope, in the lumbar area.
CPT code 62287 is used to describe a minimally invasive decompression procedure of the nucleus pulposus of an intervertebral disc in the lumbar region. This procedure involves using a needle-based technique to remove disc material, which is often done to relieve pressure on spinal nerves. The process is guided by fluoroscopic imaging or another form of indirect visualization, ensuring precision. Additionally, the use of an endoscope is involved, and the procedure may include discography and/or epidural injections at the treated level(s). This code applies whether the procedure is performed on a single or multiple levels of the lumbar spine.
For CPT code 62287, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body during the same session. It indicates that the procedure was performed bilaterally.
2. Modifier 51 - Multiple Procedures: This modifier is applied when multiple procedures are performed during the same surgical session. It helps in identifying 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 often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same provider on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by a different provider 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 modifier is used if the patient needs to return 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: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
8. Modifier LT - Left Side: This modifier is used to specify that the procedure was performed on the left side of the body.
9. Modifier RT - Right Side: This modifier is used to specify that the procedure was performed on the right side of the body.
These modifiers help in providing additional information about the procedure performed and ensure accurate billing and reimbursement. It is important to use them correctly to avoid claim denials or delays.
CPT code 62287 is a procedure that involves the decompression of the nucleus pulposus of an intervertebral disc using a percutaneous needle-based technique. When it comes to Medicare reimbursement, the determination of whether CPT code 62287 is reimbursed can depend on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the local Medicare Administrative Contractor (MAC).
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. If CPT code 62287 is listed in the MPFS, it indicates that Medicare has established a reimbursement rate for this procedure. However, the actual reimbursement can vary based on geographic location and other factors.
Additionally, MACs, which are private health insurers contracted by Medicare to process claims, play a crucial role in determining coverage and reimbursement. Each MAC may have specific local coverage determinations (LCDs) that affect whether and how a particular CPT code is reimbursed. Therefore, it is essential for healthcare providers to consult the relevant MAC's policies to understand the specific reimbursement criteria for CPT code 62287 in their region.
In summary, while CPT code 62287 may be reimbursed by Medicare if it is included in the MPFS, providers should verify the specific coverage details with their local MAC to ensure compliance with any regional policies or requirements.
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