CPT code 63047 is for a surgical procedure involving the removal of part of the vertebra to relieve pressure on the spinal cord or nerves in the lumbar region.
CPT code 63047 is used to describe a surgical procedure known as a laminectomy, facetectomy, and foraminotomy performed on the lumbar region of the spine. This procedure involves the removal of a portion of the vertebral bone called the lamina, as well as parts of the facet joints and the foramina, which are openings that allow nerve roots to exit the spinal column. The purpose of this surgery is to decompress the spinal cord, cauda equina, and/or nerve roots, which may be compressed due to conditions like spinal or lateral recess stenosis. This code applies whether the procedure is done on one side (unilateral) or both sides (bilateral) of a single vertebral segment in the lumbar spine.
For CPT code 63047, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their purposes:
1. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body during the same session.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session.
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.
4. Modifier 62 - Two Surgeons: Indicates that two surgeons worked together as primary surgeons performing distinct parts of a procedure.
5. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
6. Modifier 77 - Repeat Procedure by Another Physician: Applied when the same procedure is repeated by a different physician.
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: Used when a related procedure is performed during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that a procedure performed during the postoperative period was unrelated to the original procedure.
9. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these non-physician practitioners assist in surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 63047 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines.
The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered under Medicare Part B, including surgical procedures like those represented by CPT code 63047.
The reimbursement amount can vary based on geographic location and other factors, as determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a particular region.
Healthcare providers should consult the MPFS and their local MAC for the most accurate and up-to-date reimbursement information for CPT code 63047.
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