CPT code 19105 is for cryosurgical ablation of fibroadenomas, a procedure to freeze and destroy benign breast tumors.
CPT code 19105 is used to describe the procedure of cryosurgical ablation for a fibroadenoma, which is a benign breast tumor. This code specifically refers to the process where extreme cold is applied to destroy the abnormal tissue. The term "each" indicates that this code is used for each fibroadenoma treated during the procedure.
When using CPT code 19105 for cryosurgical ablation, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort than typically required.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both sides of the body.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same session.
4. Modifier 52 - Reduced Services
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same procedure was repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the procedure was repeated by a different physician.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period.
10. Modifier LT - Left Side
- Apply this modifier if the procedure was performed on the left side of the body.
11. Modifier RT - Right Side
- Use this modifier if the procedure was performed on the right side of the body.
12. Modifier GA - Waiver of Liability Statement Issued as Required by Payer Policy
- Apply this modifier if an Advance Beneficiary Notice (ABN) was issued to the patient.
13. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician
- Use this modifier if the procedure was performed by a resident under the supervision of a teaching physician.
14. Modifier QX - CRNA Service: With Medical Direction by a Physician
- Apply this modifier if the procedure involved a Certified Registered Nurse Anesthetist (CRNA) with medical direction by a physician.
15. Modifier QZ - CRNA Service: Without Medical Direction by a Physician
- Use this modifier if the procedure involved a CRNA without medical direction by a physician.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 19105, which is used for cryosurgical ablation, is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any applicable coverage limitations, healthcare providers should consult the MPFS. Additionally, it is essential to verify with the local Medicare Administrative Contractor (MAC) for any region-specific guidelines or requirements that may affect reimbursement for CPT code 19105.
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