CPT code 63090 is for a procedure involving partial or complete removal of a vertebral body to relieve pressure on the spinal cord or nerves.
CPT code 63090 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 either a transperitoneal or retroperitoneal approach, meaning the surgeon accesses the spine through the abdominal cavity or behind the peritoneum, respectively. The primary goal of this surgery is to decompress the spinal cord, cauda equina, or nerve roots in the lower thoracic, lumbar, or sacral regions of the spine. This code specifically applies to the procedure when it is performed on a single spinal segment.
For CPT code 63090, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased intensity, time, technical difficulty, severity of the patient's condition, or physical and mental effort required.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed bilaterally, this modifier should be used to indicate that the procedure was performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier is used to indicate 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 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier is used to indicate that both surgeons are involved in the procedure.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day.
8. 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 when a patient requires a return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure performed during the postoperative period is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help perform the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 63090 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 policies set 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 can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) established by the MACs.
These contractors have the authority to interpret national policies and establish regional guidelines, which can affect whether and how a particular CPT code like 63090 is reimbursed. Therefore, it is crucial for healthcare providers to verify the specific coverage details with their local MAC to ensure compliance and proper reimbursement for this procedure.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 63090, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and enhance your revenue cycle management.
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