CPT code 01938 is used for anesthesia services during lumbar or sacral spine procedures involving drainage or aspiration.
CPT code 01938 is used to describe anesthesia services provided during a procedure involving the drainage or aspiration of the lumbar or sacral region. This code is specifically utilized by anesthesiologists or anesthesia providers to document and bill for the administration of anesthesia during such procedures, ensuring that the patient remains comfortable and pain-free while the medical team performs the necessary intervention in the lower back or pelvic area.
When dealing with CPT code 01938, which pertains to anesthesia services, there are several modifiers that may be applicable. These modifiers are used to provide additional information about the service provided and can affect reimbursement. Here is a list of potential modifiers that could be used with CPT code 01938:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 23 (Unusual Anesthesia): This modifier is applicable when a procedure that usually requires either 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 indicates that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
5. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 77 (Repeat Procedure by Another Physician): This is used when a procedure or service is repeated by another physician or qualified healthcare professional 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 modifier is used when a procedure or service is performed by the same physician during the postoperative period of the initial procedure, but it is unrelated to the original procedure.
9. Modifier AA (Anesthesia Services Performed Personally by Anesthesiologist): This modifier is used to indicate 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 modifier is used when an anesthesiologist provides medical direction for two to four concurrent anesthesia procedures.
11. Modifier QS (Monitored Anesthesia Care Service): This is used to indicate that monitored anesthesia care (MAC) was provided.
12. Modifier QX (CRNA Service with Medical Direction by a Physician): This modifier 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 CRNA by an Anesthesiologist): This is used when an anesthesiologist provides medical direction for one CRNA.
14. Modifier QZ (CRNA Service without Medical Direction by a Physician): This modifier is used when a CRNA provides anesthesia services without the medical direction of a physician.
Each of these modifiers serves a specific purpose and should be used in accordance with the specific circumstances of the anesthesia service provided. Proper use of modifiers ensures accurate billing and reimbursement.
The CPT code 01938 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies set by the Medicare Administrative Contractor (MAC) for your specific region.
The MPFS provides a comprehensive list of services covered by Medicare and their respective reimbursement rates, while the MACs are responsible for interpreting national policies and setting local coverage determinations that may affect whether a particular CPT code is reimbursed.
Therefore, to confirm if CPT code 01938 is reimbursed, healthcare providers should consult the MPFS for the current year and check with their regional MAC for any specific coverage guidelines or restrictions that may apply.
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