CPT code 61735 is for creating a lesion using a stereotactic method in subcortical structures, excluding the globus pallidus or thalamus.
CPT code 61735 is used to describe a surgical procedure that involves creating a lesion in the brain using a stereotactic method. This procedure includes making one or more burr holes in the skull and employing techniques to localize and record the targeted area. The focus of this code is on subcortical structures in the brain, excluding the globus pallidus or thalamus. This code is applicable whether the procedure is performed in a single stage or multiple stages. It is typically used in the context of treating certain neurological conditions where precise targeting within the brain is necessary.
For CPT code 61735, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 (Increased Procedural Services): Use this modifier if 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 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
3. Modifier 52 (Reduced Services): Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion. Documentation should support the reduction in services.
4. Modifier 59 (Distinct Procedural Service): Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. 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.
6. Modifier 77 (Repeat Procedure by Another Physician): Use this modifier when the same 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): This modifier 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): Apply this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required for the procedure.
10. Modifier 82 (Assistant Surgeon [when qualified resident surgeon not available]): Use this modifier when an assistant surgeon is required, and a qualified resident surgeon is not available.
11. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used when a non-physician practitioner assists in the surgery.
Each modifier should be used in accordance with the specific circumstances of the procedure and payer requirements. Proper documentation is essential to justify the use of any modifier.
The CPT code 61735 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) for 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 final determination of whether CPT code 61735 is reimbursed can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) issued by the MACs.
These contractors have the authority to interpret Medicare policy and establish specific coverage criteria, which can affect whether a particular service is reimbursed. Therefore, it is essential for healthcare providers to consult the MPFS and their regional MAC to confirm the reimbursement status of CPT code 61735.
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