CPT code 19085 is a procedure for a breast biopsy of the first lesion using MRI guidance.
CPT code 19085 is used to describe a procedure where a biopsy is performed on the first lesion in the breast using magnetic resonance imaging (MRI) guidance. This code is specifically for the initial lesion being biopsied and includes the imaging guidance necessary to accurately locate and sample the tissue.
For CPT code 19085, which pertains to a breast biopsy of the first lesion using magnetic resonance imaging (MRI) guidance, 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. It indicates that the provider is billing for the interpretation of the MRI guidance and the biopsy procedure.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the use of the equipment and the technical staff involved in the MRI guidance and biopsy procedure.
3. Modifier 50 - Bilateral Procedure: This modifier is used if the biopsy is performed on both breasts during the same session. It indicates that the procedure was performed bilaterally.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the biopsy procedure is distinct or independent from other services performed on the same day. It helps to avoid bundling issues and ensures that the biopsy is recognized as a separate service.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same physician repeats the biopsy procedure on the same day. It indicates that the procedure was necessary to be performed again.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if a different physician repeats the biopsy procedure on the same day. It indicates that the procedure was necessary to be performed again by another provider.
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 procedure room for a related biopsy 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 biopsy procedure is unrelated to the original procedure performed during the postoperative period.
9. Modifier 99 - Multiple Modifiers: This modifier is used when more than four modifiers are necessary to describe the service. It indicates that multiple modifiers are being applied to the procedure.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement for the services provided.
The CPT code 19085, which pertains to a specific medical procedure, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for various CPT codes, including 19085. Additionally, it is important to consult with your local Medicare Administrative Contractor (MAC) for any region-specific guidelines or variations in reimbursement policies. The MAC is responsible for processing Medicare claims and can provide further clarification on coverage and payment for CPT code 19085.
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