CPT code 63064 is for a procedure involving the costovertebral approach to relieve pressure on the spinal cord or nerve roots in the thoracic area.
CPT code 63064 is used to describe a surgical procedure involving the costovertebral approach to decompress the spinal cord or nerve roots in the thoracic region. This procedure is typically performed to address issues such as a herniated intervertebral disc. The code specifically applies to the decompression of a single segment within the thoracic spine. This approach involves accessing the spine through the costovertebral junction, which is where the ribs meet the vertebrae, to relieve pressure on the spinal cord or nerve roots, thereby alleviating pain or neurological symptoms.
For CPT code 63064, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their reasons for use:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to unusual anatomy or other complicating factors.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier should be used to indicate that it was a bilateral procedure.
3. Modifier 51 - Multiple Procedures: Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed.
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. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Use this modifier if the same procedure is repeated by the same provider on the same day.
6. 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.
7. 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 applicable if the patient needs to return to the operating room for a related procedure during the postoperative period.
8. 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 the two are unrelated.
9. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be used.
10. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required for a minimal portion of the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier when an assistant surgeon is necessary because a qualified resident is not available.
12. 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.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific policies to ensure correct usage.
The CPT code 63064 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the local Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates. However, the final decision on reimbursement can vary based on the MAC's interpretation of local coverage determinations (LCDs) and national coverage determinations (NCDs).
Therefore, healthcare providers should verify the specific reimbursement details for CPT code 63064 with their respective MAC to ensure compliance with Medicare's billing requirements and to understand any regional variations in coverage.
Discover the power of MD Clarity's RevFind software to ensure you're receiving every dollar you're owed. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 63064, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and maximize your revenue.
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
