CPT code 19000 is used for the drainage of a breast lesion, a procedure to remove fluid or pus from a breast lump.
CPT code 19000 is used for the procedure involving the drainage of a breast lesion. This code is specifically designated for instances where a healthcare provider needs to remove fluid or pus from a cyst, abscess, or other types of lesions in the breast. The procedure typically involves using a needle or small incision to access the lesion and drain the contents, which can help alleviate pain, reduce infection, and provide diagnostic information.
For CPT code 19000 (Drainage of breast lesion), the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both breasts.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same session.
3. Modifier 52 - Reduced Services: Used if the procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 59 - Distinct Procedural Service: Indicates that the procedure is distinct or independent from other services performed on the same day.
5. Modifier LT - Left Side: Used to specify that the procedure was performed on the left breast.
6. Modifier RT - Right Side: Used to specify that the procedure was performed on the right breast.
7. Modifier 76 - Repeat Procedure by Same Physician: Used if the same procedure is repeated by the same physician on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician: Used if the same procedure is repeated by a different physician on the same day.
9. 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 if the patient returns to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used if an unrelated procedure is performed by the same physician during the postoperative period.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 19000 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for CPT code 19000. Providers should consult their respective MACs to ensure compliance with regional guidelines and to obtain accurate reimbursement information.
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