CPT CODES

CPT Code 01190

CPT code 01190 is used for procedures involving anesthesia during the removal of a pelvic nerve.

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What is CPT Code 01190

CPT code 01190 is used to describe the anesthesia services provided for the surgical procedure involving the removal of a nerve in the pelvic region. This code is specifically utilized by anesthesiologists and other healthcare providers to document and bill for the anesthesia care given during such a procedure. The use of this code ensures that the anesthesia services are accurately captured for reimbursement purposes, reflecting the complexity and specific nature of the surgical intervention in the pelvic area.

Does CPT 01190 Need a Modifier?

For CPT code 01190, which pertains to anesthesia for procedures on the pelvis involving nerve removal, the following modifiers may be applicable:

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 apply if the anesthesia procedure is more complex or time-consuming than usual.

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 may be necessary if multiple procedures are performed that are not typically reported together.

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.

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.

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 is used when a patient returns 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 99 - Multiple Modifiers: This is used when two or more modifiers are necessary to describe the service provided.

These modifiers help provide additional information about the circumstances under which the anesthesia service was provided, ensuring accurate billing and reimbursement. It's important to review the specific payer policies and guidelines to determine the appropriate use of these modifiers.

CPT Code 01190 Medicare Reimbursement

CPT code 01190, which pertains to a specific medical procedure, is subject to reimbursement considerations under Medicare. To determine if Medicare reimburses this code, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually.

Additionally, it is important to consult with the relevant Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement for CPT code 01190. They may also offer insights into any local coverage determinations (LCDs) that could affect reimbursement.

Ultimately, whether CPT code 01190 is reimbursed by Medicare will depend on its inclusion in the MPFS and any specific policies or guidelines set forth by the MAC in your area. Therefore, it is crucial for healthcare providers to stay informed about updates to the MPFS and maintain communication with their MAC to ensure accurate billing and reimbursement.

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