CPT code 19103 is a procedure code for a percutaneous breast biopsy using a device.
CPT code 19103 is used to describe a procedure where a sample of breast tissue is taken using a needle or other device without making a large incision. This is typically done to check for abnormalities or diagnose conditions such as breast cancer. The term "percut" refers to the percutaneous method, meaning the procedure is performed through the skin.
When using CPT code 19103 for a breast biopsy performed percutaneously with a device, 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 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or unusual circumstances.
2. Modifier 26 - Professional Component
- This modifier is used when only the professional component of the service is being billed, such as the interpretation of the biopsy results.
3. Modifier 50 - Bilateral Procedure
- Apply this modifier if the biopsy was performed on both breasts during the same session.
4. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure
- This modifier is applicable 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
- Use this modifier 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
- Apply this modifier if the same physician performed the biopsy procedure more than once on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician performed the biopsy procedure more than once 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
- This modifier is used if the patient had to return 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
- Apply this modifier if the biopsy was performed during the postoperative period of another procedure but is unrelated to the initial procedure.
11. Modifier LT - Left Side
- Use this modifier to specify that the biopsy was performed on the left breast.
12. Modifier RT - Right Side
- Use this modifier to specify that the biopsy was performed on the right breast.
13. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician
- Apply this modifier if the procedure was performed by a resident under the supervision of a teaching physician.
14. Modifier QW - CLIA-Waived Test
- Use this modifier if the biopsy involves a test that is CLIA-waived.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 19103, which is for a specific medical procedure, is subject to reimbursement by Medicare. 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 for services covered under Medicare Part B. Additionally, it is important to consult with your local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement for CPT code 19103. Each MAC may have slightly different policies and interpretations, so their input is crucial for accurate billing and reimbursement.
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