CPT code 00406 is used for anesthesia services during breast surgery, ensuring accurate documentation and reimbursement for healthcare providers.
CPT code 00406 is used to describe anesthesia services provided during surgical procedures on the breast. This code is specifically utilized by anesthesiologists and other qualified healthcare professionals to document and bill for the administration of anesthesia during breast surgeries. The use of this code ensures that the anesthesia services are accurately recorded for reimbursement purposes, reflecting the complexity and specific requirements of the surgical procedure being performed on the breast.
When dealing with CPT code 00406, which pertains to anesthesia for surgery of the breast, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide the service is substantially greater than typically required. This could be due to unusual procedural complications or patient conditions.
2. Modifier 23 - Unusual Anesthesia: This modifier is applicable when a procedure that usually requires no anesthesia or local anesthesia must be performed under general anesthesia due to unusual circumstances.
3. Modifier 47 - Anesthesia by Surgeon: This is used when the surgeon administers regional or general anesthesia to the patient. It is not applicable for local anesthesia.
4. 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 often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This is used when a procedure or service is repeated by the same provider subsequent to the original procedure or service.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is used when a procedure or service is repeated by a different provider subsequent to the original procedure or service.
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 patient requires a 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: This is used when a procedure performed during the postoperative period is unrelated to the original procedure.
9. Modifier AA - Anesthesia Services Performed Personally by Anesthesiologist: This modifier indicates that the anesthesia services were personally performed by an anesthesiologist.
10. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals: This is used when an anesthesiologist is directing multiple anesthesia procedures concurrently.
11. Modifier QS - Monitored Anesthesia Care Service: This indicates that the service provided was monitored anesthesia care.
12. Modifier QX - CRNA Service: With Medical Direction by a Physician: This is used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the medical direction of a physician.
13. Modifier QY - Medical Direction of One Certified Registered Nurse Anesthetist (CRNA) by an Anesthesiologist: This indicates that an anesthesiologist is directing one CRNA.
14. Modifier QZ - CRNA Service: Without Medical Direction by a Physician: This is used when a CRNA provides anesthesia services without the medical direction of a physician.
These modifiers help provide additional context and specificity to the billing and documentation of anesthesia services related to breast surgery, ensuring accurate and appropriate reimbursement.
CPT code 00406 is reimbursed by Medicare, but the reimbursement is subject to several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including anesthesia services like those associated with CPT code 00406. However, the actual reimbursement can vary based on geographic location and other factors determined by the Medicare Administrative Contractor (MAC) for your region. Each MAC has the authority to interpret national policies and establish local coverage determinations, which can influence whether and how much Medicare reimburses for specific CPT codes. Therefore, it is essential to consult the MPFS and your local MAC guidelines to determine the exact reimbursement details for CPT code 00406.
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