CPT code 19001 is used for the additional procedure of draining a breast lesion, typically added to the primary procedure for comprehensive billing.
CPT code 19001 is an add-on code used to report the drainage of an additional breast lesion. This code is used when a healthcare provider performs a procedure to remove fluid from a second or subsequent breast lesion, following the initial drainage procedure. It is important to note that this code should be used in conjunction with the primary procedure code for the first lesion drainage.
For CPT code 19001, which is an add-on code for draining a breast lesion, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed, typically when the provider is interpreting the results but not providing the equipment or technical staff.
2. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both breasts during the same session.
3. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same session. Since 19001 is an add-on code, it would typically be used in conjunction with the primary procedure code.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It may be used if the add-on procedure is performed in a different session or site.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if the same procedure is repeated by a different physician on the same day.
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 if the patient needs to 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 if the procedure is unrelated to the original procedure and is performed during the postoperative period.
9. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used if the same diagnostic test is repeated on the same day to obtain subsequent (multiple) test results.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 19001, which is an add-on code, is reimbursed by Medicare under specific conditions. Reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries. Additionally, the reimbursement may vary based on the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. It is essential to consult the MPFS and your local MAC to confirm the exact reimbursement details and any specific requirements or limitations that may apply to CPT code 19001.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level, including specific codes like 19001, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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