CPT code 19101 is for an open biopsy of the breast, a surgical procedure to remove a sample of breast tissue for examination.
CPT code 19101 is a medical billing code used to describe the procedure of performing an open biopsy of the breast. This involves surgically removing a small sample of breast tissue for examination under a microscope to diagnose abnormalities, such as cancer or other breast conditions. The term "open" indicates that the biopsy is done through a surgical incision, as opposed to a needle biopsy, which is less invasive.
For CPT code 19101 (Biopsy of breast, open), the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Used when the procedure is performed on both breasts during the same operative session.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session.
3. Modifier 59 - Distinct Procedural Service: Used to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier LT - Left Side: Indicates that the procedure was performed on the left breast.
5. Modifier RT - Right Side: Indicates that the procedure was performed on the right breast.
6. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required.
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 by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: 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.
These modifiers help provide additional context and specificity for the procedure, ensuring accurate billing and reimbursement.
CPT code 19101 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code. To determine the exact reimbursement rate for CPT code 19101, healthcare providers should refer to the MPFS.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and determining local coverage decisions. Each MAC may have specific guidelines and policies that can influence the reimbursement process for CPT code 19101. Therefore, it is essential for healthcare providers to consult their respective MAC for detailed information on coverage and reimbursement for this specific code.
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