CPT code 10080 is for the drainage of a pilonidal cyst, a procedure to remove fluid or pus from a cyst near the tailbone.
CPT code 10080 is used for the procedure involving the drainage of a pilonidal cyst. This code is specifically assigned to the medical service where a healthcare provider makes an incision to drain the cyst, which is typically located near the tailbone and can cause significant discomfort. The procedure helps to relieve pain and prevent further infection.
For CPT code 10080, which pertains to the drainage of a pilonidal cyst, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. This modifier is used if an E/M service is provided on the same day as the drainage procedure and is distinct from the procedure itself.
2. Modifier 50: Bilateral procedure. This modifier is used if the procedure is performed on both sides of the body.
3. Modifier 51: Multiple procedures. This modifier is used when multiple procedures are performed during the same surgical session.
4. Modifier 52: Reduced services. This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
5. 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.
6. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is used if the same procedure is repeated on the same day by the same provider.
7. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is used if the same procedure is repeated on the same day by a different provider.
8. Modifier 78: Unplanned return to the operating/procedure room by the same physician or other qualified healthcare professional following initial procedure for a related procedure during the postoperative period. This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79: Unrelated procedure or service by the same physician or other qualified healthcare professional during the postoperative period. This modifier is used if an unrelated procedure is performed by the same provider during the postoperative period of the initial procedure.
10. Modifier 80: Assistant surgeon. This modifier is used if an assistant surgeon is required during the procedure.
11. Modifier 81: Minimum assistant surgeon. This modifier is used if a minimum assistant surgeon is required during the procedure.
12. Modifier 82: Assistant surgeon (when qualified resident surgeon not available). This modifier is used if an assistant surgeon is required because a qualified resident surgeon is not available.
13. Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery. This modifier is used if a physician assistant, nurse practitioner, or clinical nurse specialist assists during the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed and ensure accurate billing and reimbursement.
The CPT code 10080 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services rendered by physicians and other healthcare professionals.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for this CPT code. Therefore, it is essential to consult the relevant MAC for your region to understand any specific guidelines or limitations that may apply to the reimbursement of CPT code 10080.
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