CPT code 63085 is for a surgical procedure involving partial or complete removal of a vertebral body in the thoracic spine to relieve pressure on the spinal cord.
CPT code 63085 is used to describe a surgical procedure known as a vertebral corpectomy, which involves the partial or complete removal of a vertebral body. This procedure is performed using a transthoracic approach, meaning the surgeon accesses the spine through the chest. The primary goal of this surgery is to decompress the spinal cord and/or nerve roots in the thoracic region of the spine, specifically targeting a single segment. This type of procedure is typically necessary when there is significant compression on the spinal cord or nerves due to conditions such as tumors, fractures, or degenerative diseases.
For CPT code 63085, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed bilaterally, this modifier should be used to indicate that the same procedure was performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: This is used 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 used to identify procedures that are not normally reported together but are appropriate under the circumstances.
5. 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.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is used when the same procedure is repeated by a different provider.
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 is used when a related procedure is performed during the postoperative period of the initial procedure.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when an unrelated procedure is performed by the same provider during the postoperative period.
9. Modifier 80 - Assistant Surgeon: This is used when an assistant surgeon is required for the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: This is used when a minimum assistant surgeon is required for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is required because a qualified resident surgeon is not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This is used when these non-physician practitioners assist in surgery.
Each modifier should be used in accordance with the specific circumstances of the procedure and payer requirements. Proper documentation is essential to support the use of any modifier.
CPT code 63085 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 guidelines set forth by the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, the actual reimbursement for CPT code 63085 can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) established by the MACs.
These contractors are responsible for interpreting Medicare policies and setting specific guidelines that can affect whether and how a particular service is reimbursed. Therefore, it is crucial for healthcare providers to consult their regional MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 63085.
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