CPT code 63252 is for a surgical procedure involving the removal or treatment of an abnormal blood vessel formation in the thoracolumbar spinal cord.
CPT code 63252 is used to describe a surgical procedure known as a laminectomy, specifically performed for the excision or occlusion of an arteriovenous malformation (AVM) located in the spinal cord at the thoracolumbar region. This procedure involves the removal of a portion of the vertebral bone called the lamina to access the spinal cord and address the AVM, which is an abnormal connection between arteries and veins that can disrupt normal blood flow and potentially lead to neurological issues. The thoracolumbar region refers to the area of the spine where the thoracic and lumbar sections meet, typically involving the lower part of the thoracic spine and the upper part of the lumbar spine. This code is utilized by healthcare providers to accurately document and bill for this specific surgical intervention.
For CPT code 63252, which pertains to a laminectomy for excision or occlusion of an arteriovenous malformation of the spinal cord in the thoracolumbar region, 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 complexity or time.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was 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 used to identify procedures that are not normally reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is used to indicate the collaborative effort.
5. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the services of several physicians, often of different specialties, working together as a team.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same provider.
7. 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.
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 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 of the procedure, ensuring accurate billing and reimbursement. It is important to review the specific payer guidelines as they may have unique requirements for the use of these modifiers.
The CPT code 63252 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the payment rates for each service. However, the actual reimbursement for CPT code 63252 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting local coverage determinations, which can influence whether and how much Medicare reimburses for this specific procedure. Healthcare providers should consult their local MAC for detailed information on coverage and reimbursement rates for CPT code 63252.
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 63252, 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.
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
