CPT code 61867 is for a procedure involving the placement of a neurostimulator electrode array in the brain using advanced imaging and recording techniques.
CPT code 61867 is used to describe a surgical procedure involving the creation of an opening in the skull, such as a twist drill, burr hole, craniotomy, or craniectomy, to implant a neurostimulator electrode array in a specific subcortical area of the brain. This procedure targets regions like the thalamus, globus pallidus, subthalamic nucleus, periventricular area, or periaqueductal gray. The process includes the use of intraoperative microelectrode recording to ensure precise placement of the first electrode array. This code is typically used in the context of treating neurological conditions that may benefit from deep brain stimulation.
For CPT code 61867, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could apply if there are unforeseen complexities during the implantation process.
2. Modifier 51 (Multiple Procedures): Applicable if multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
3. Modifier 59 (Distinct Procedural Service): Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This could be relevant if the implantation is performed in conjunction with other unrelated procedures.
4. Modifier 62 (Two Surgeons): If two surgeons are required to perform distinct parts of the procedure, this modifier indicates that both are involved in the surgery.
5. Modifier 76 (Repeat Procedure by Same Physician): Used if the same procedure is repeated by the same physician on the same day.
6. Modifier 77 (Repeat Procedure by Another Physician): Used if 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): Applicable 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): Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 80 (Assistant Surgeon): Indicates that an assistant surgeon was necessary for the procedure.
10. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is required, and a qualified resident 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 61867 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines. The Medicare Physician Fee Schedule (MPFS) provides the framework for determining the reimbursement rates for this procedure. The MPFS outlines the payment amounts based on the relative value units (RVUs) assigned to the procedure, which take into account the work, practice expense, and malpractice components.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing claims and ensuring that the services billed are covered under Medicare guidelines. They may have specific local coverage determinations (LCDs) that further define the conditions under which CPT code 61867 is reimbursed. Therefore, it is essential for healthcare providers to verify the specific requirements and guidelines set forth by their respective MAC to ensure proper reimbursement for this procedure.
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