CPT code 63086 is for a thoracic vertebral corpectomy via a transthoracic approach, involving spinal cord or nerve root decompression.
CPT code 63086 is used to describe a surgical procedure known as a vertebral corpectomy, which involves the partial or complete removal of a vertebral body through a transthoracic approach. This procedure is performed in the thoracic region of the spine and includes the decompression of the spinal cord and/or nerve roots. The code specifically applies to each additional segment treated beyond the primary procedure, meaning it is listed separately in addition to the main procedure code. This is typically used when multiple segments of the spine require surgical intervention during the same operative session.
For CPT code 63086, the following modifiers may be applicable:
1. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. Since CPT 63086 is an add-on code, it may be used in conjunction with a primary procedure, and Modifier 51 could be applied if other distinct procedures are performed.
2. 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 may be necessary if the procedure is performed in a separate anatomical site or through a separate incision.
3. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that each surgeon is performing a distinct part of the procedure.
4. Modifier 66 - Surgical Team: This modifier is used when a highly complex procedure requires the skills of a surgical team. It may be applicable if the procedure involves multiple specialists working together.
5. Modifier 76 - Repeat Procedure by Same Physician: If the procedure needs to be repeated by the same physician, this modifier indicates that the repeat procedure was necessary.
6. Modifier 77 - Repeat Procedure by Another Physician: Similar to Modifier 76, but used when the repeat procedure is performed by a different physician.
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 used 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: This modifier is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific policies to ensure correct usage.
CPT code 63086, which involves a specific surgical procedure, is subject to reimbursement considerations under Medicare. To determine if this code is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with their respective reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in interpreting and implementing Medicare policies at the regional level. They may have specific guidelines or coverage determinations that affect the reimbursement of CPT code 63086. Therefore, healthcare providers should verify with their local MAC to confirm whether this particular code is reimbursed and to understand any specific billing requirements or documentation needed for successful claims processing.
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