CPT code 19102 is a procedure code for a percutaneous breast biopsy with imaging guidance.
CPT code 19102 is used to describe a percutaneous breast biopsy procedure that is performed with the assistance of imaging guidance. This means that a healthcare provider uses a needle to remove a small sample of breast tissue for examination, and they use imaging technology, such as ultrasound or mammography, to accurately locate the area of concern within the breast. This code is essential for billing and documentation purposes, ensuring that the procedure is properly recorded and reimbursed.
When using CPT code 19102 for a breast biopsy performed percutaneously with imaging guidance, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, such as the interpretation of the imaging guidance.
2. Modifier TC - Technical Component: Used when only the technical component of the service is being billed, such as the use of imaging equipment.
3. Modifier 50 - Bilateral Procedure: Used if the biopsy is performed on both breasts during the same session.
4. Modifier 52 - Reduced Services: Used if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used if the procedure was 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 biopsy was a distinct procedural service 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: Used if the patient returns to the operating or procedure 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 the biopsy is performed during the postoperative period of another procedure but is unrelated to the original 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.
By appropriately applying these modifiers, healthcare providers can ensure accurate billing and reimbursement for the services rendered.
The CPT code 19102, which is for a specific medical procedure, is subject to reimbursement by Medicare, but this depends on several factors. Medicare reimbursement for CPT code 19102 is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided by physicians and other healthcare professionals.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in this process. MACs are responsible for processing Medicare claims and have the authority to make local coverage determinations (LCDs) that can affect whether a particular CPT code is reimbursed in their jurisdiction. Therefore, while CPT code 19102 is generally reimbursable under Medicare, providers should consult the MPFS and their specific MAC's guidelines to confirm coverage and reimbursement rates.
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