CPT code 63087 is for a procedure involving partial or complete removal of a vertebral body in the lower thoracic or lumbar spine to relieve nerve pressure.
CPT code 63087 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 combined thoracolumbar approach, which means the surgeon accesses the spine through both the thoracic (mid-back) and lumbar (lower back) regions. The primary goal of this surgery is to decompress the spinal cord, cauda equina, or nerve roots, which may be under pressure due to conditions such as spinal tumors, fractures, or degenerative diseases. This specific code applies to the procedure when it is performed on a single segment of the lower thoracic or lumbar spine.
For CPT code 63087, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as increased intensity, time, technical difficulty, or severity of the patient's condition.
2. Modifier 51 (Multiple Procedures): Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
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 particularly relevant if the procedure is not typically reported together with another service.
4. Modifier 62 (Two Surgeons): If two surgeons are required to perform the procedure due to its complexity, this modifier should be used to indicate that each surgeon performed a distinct part of the procedure.
5. Modifier 76 (Repeat Procedure by Same Physician): Use this modifier if the same procedure is repeated by the same physician on the same day.
6. Modifier 77 (Repeat Procedure by Another Physician): This modifier is applicable if the procedure is repeated by a different physician 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): Use this modifier 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 it is unrelated to the original procedure.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 63087 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 list of services covered by Medicare and assigns relative value units (RVUs) to each service, which are used to calculate reimbursement rates.
However, the final decision on whether CPT code 63087 is reimbursed, and at what rate, can vary based on the specific guidelines and coverage determinations set forth by the MAC in your region.
It is essential for healthcare providers to verify the specific reimbursement details with their local MAC to ensure compliance and accurate billing.
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