CPT code 19083 is a procedure for a breast biopsy of the first lesion using ultrasound imaging.
CPT code 19083 is used for a biopsy of the breast, specifically targeting the first lesion, and includes the use of ultrasound imaging to guide the procedure. This code is applicable when a healthcare provider needs to extract a sample of breast tissue for examination, and the ultrasound helps ensure precise targeting of the lesion.
When billing for CPT code 19083, which pertains to a breast biopsy of the first lesion using ultrasound imaging, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, typically by the radiologist or the physician performing the interpretation.
2. Modifier TC - Technical Component: Used when only the technical component of the service is being billed, typically by the facility providing the equipment and technical support.
3. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both breasts during the same session.
4. Modifier 52 - Reduced Services: Used if the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used if the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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.
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 of the initial procedure.
11. Modifier LT - Left Side: Used to specify that the procedure was performed on the left breast.
12. Modifier RT - Right Side: Used to specify that the procedure was performed on the right breast.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 19083, which involves a specific medical procedure, is subject to reimbursement by Medicare under certain conditions. To determine if this code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates and coverage policies for various CPT codes.
Additionally, it is essential to consult with the relevant Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can provide specific guidance on whether CPT code 19083 is covered and any documentation requirements that must be met for reimbursement. By checking both the MPFS and consulting with your MAC, you can ensure accurate and compliant billing for this procedure.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 19083. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
