CPT code 10081 is for the drainage of a pilonidal cyst, a procedure to remove fluid or pus from a cyst located near the tailbone.
CPT code 10081 is used for the procedure involving the drainage of a pilonidal cyst. This code is specifically assigned to the surgical intervention where a healthcare provider makes an incision to drain the cyst, which typically forms near the tailbone and can become infected or filled with pus. This procedure helps to alleviate pain and prevent further infection.
For CPT code 10081 (Drainage of pilonidal cyst), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Used when an evaluation and management service provided during a postoperative period is unrelated to the original procedure.
3. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Used when a significant, separately identifiable evaluation and management service is performed by the same physician on the same day as the procedure.
4. Modifier 50 - Bilateral Procedure: Used when the procedure is performed on both sides of the body.
5. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same session by the same provider.
6. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
7. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. 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.
9. Modifier 76 - Repeat Procedure or Service by Same Physician: Used when a procedure or service is repeated by the same physician subsequent to the original procedure or service.
10. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician subsequent to the original procedure or service.
11. 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 of the initial procedure.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when a non-physician provider assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 10081 is reimbursed by Medicare, but the reimbursement rate can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the standard rates for services covered by Medicare, including CPT code 10081. However, the final reimbursement amount may also depend on the specific Medicare Administrative Contractor (MAC) that processes claims in your region. Each MAC may have slight variations in how they interpret and apply the MPFS, so it's essential to verify the exact reimbursement details with your local MAC.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 10081. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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