CPT code 19100 is a procedure for a breast biopsy performed percutaneously without imaging guidance.
CPT code 19100 is a medical billing code used to describe a procedure where a breast biopsy is performed percutaneously (through the skin) without the use of imaging guidance. This means that a sample of breast tissue is taken using a needle, but no imaging technology, such as ultrasound or mammography, is used to guide the needle to the correct location. This code is used by healthcare providers to document and bill for this specific type of breast biopsy procedure.
For CPT code 19100, which pertains to a biopsy of the breast performed percutaneously without imaging guidance, 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 physician.
2. Modifier TC - Technical Component: Used when only the technical component of the service is being billed, typically by the facility.
3. Modifier 50 - Bilateral Procedure: Used when the procedure is performed on both breasts during the same session.
4. Modifier 52 - Reduced Services: Used when the service provided is less than what is typically required for the procedure.
5. Modifier 53 - Discontinued Procedure: Used when 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 the procedure is distinct or independent from other services performed on the same day.
7. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician on the same day.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Used when 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 when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 99 - Multiple Modifiers: Used when two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
CPT code 19100, which refers to a specific medical procedure, is subject to reimbursement by Medicare under certain conditions. To determine if this code is reimbursed, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the reimbursement rates and coverage policies for various CPT codes.
Additionally, it is crucial to verify the specific guidelines and coverage determinations set forth by the Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can provide localized information on whether CPT code 19100 is reimbursed and under what circumstances. Therefore, checking both the MPFS and the relevant MAC guidelines will provide a comprehensive understanding of the reimbursement status for CPT code 19100.
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