CPT code 62351 is for placing or adjusting a catheter in the spine for long-term medication delivery, involving a laminectomy procedure.
CPT code 62351 is used to describe a surgical procedure involving the implantation, revision, or repositioning of a tunneled intrathecal or epidural catheter. This catheter is intended for long-term medication administration and is connected to either an external pump or an implantable reservoir/infusion pump. The procedure includes a laminectomy, which is a surgical operation to remove a portion of the vertebral bone called the lamina. This code is typically utilized when a healthcare provider needs to ensure precise delivery of medication directly into the spinal fluid or epidural space, often for pain management or treatment of chronic conditions.
For CPT code 62351, 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 59 (Distinct Procedural Service): Apply this modifier to indicate that the procedure is distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 76 (Repeat Procedure by Same Physician): Use this modifier if the same procedure is repeated by the same physician on the same day.
5. 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.
6. 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 returns to the operating room for a related procedure during the postoperative period.
7. 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.
8. Modifier 80 (Assistant Surgeon): Apply this modifier if an assistant surgeon is required for the procedure.
9. Modifier 82 (Assistant Surgeon - When Qualified Resident Surgeon Not Available): Use this modifier when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
10. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used when a non-physician provider assists in the surgery.
Each modifier should be used in accordance with payer policies and supported by appropriate documentation in the patient's medical record.
The CPT code 62351 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that outlines the payment rates for services covered under Medicare Part B, including those associated with CPT codes. To determine if CPT code 62351 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the associated reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make local coverage determinations (LCDs) that can affect whether a specific CPT code, such as 62351, is reimbursed in their jurisdiction. Providers should check with their respective MAC to ensure that CPT code 62351 is covered and to understand any specific documentation or medical necessity requirements that may apply.
In summary, while CPT code 62351 can be reimbursed by Medicare, it is essential for healthcare providers to verify its inclusion in the MPFS and consult with their MAC for any local coverage policies that might impact reimbursement.
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