CPT code 19110 is a medical billing code used to describe the procedure of nipple exploration for diagnostic or therapeutic purposes.
CPT code 19110 is used to describe a medical procedure known as nipple exploration. This procedure involves a detailed examination of the nipple area to investigate any abnormalities, such as lumps, discharge, or other concerning symptoms. The goal is to diagnose potential issues and determine the appropriate course of treatment.
For CPT code 19110 (Nipple exploration), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same session.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when a procedure or service is repeated by the same physician or other qualified healthcare professional.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician or other qualified healthcare professional.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician: Used for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used for an unrelated procedure or service by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these professionals assist in surgery.
Each of these modifiers serves a specific purpose and should be used according to the specific circumstances of the procedure to ensure accurate billing and reimbursement.
The CPT code 19110, which pertains to nipple exploration, is reimbursed by Medicare under specific conditions. To determine if this code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare. Additionally, it is essential to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as they provide guidance on coverage policies and any local coverage determinations (LCDs) that may affect reimbursement. Always ensure that the service meets the medical necessity criteria established by Medicare to qualify for reimbursement.
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