CPT code 19112 is for the excision of a breast duct fistula, a procedure to remove an abnormal connection in the breast duct.
CPT code 19112 is used to describe the surgical procedure for excising a breast duct fistula. This involves the removal of an abnormal connection or passageway that has developed between a breast duct and the skin or another part of the breast tissue. The procedure aims to eliminate the fistula to prevent infection, discharge, or other complications.
When using CPT code 19112 for excision of a breast duct fistula, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort or complexity than typically required.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both breasts during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same surgical 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 LT - Left Side
- Apply this modifier if the procedure was performed on the left breast.
7. Modifier RT - Right Side
- Use this modifier if the procedure was performed on the right breast.
8. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same procedure was repeated by the same physician on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the same procedure was repeated by a different physician on the same day.
10. 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 required an unplanned return to the operating room for a related procedure during the postoperative period.
11. 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.
12. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon was required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required during the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted during the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
When considering whether the CPT code 19112 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by your regional Medicare Administrative Contractor (MAC). The MPFS is a comprehensive listing of the fees Medicare uses to reimburse physicians and other healthcare providers for services rendered. Each MAC, which administers Medicare claims for specific regions, may have additional guidelines or requirements for reimbursement.
For CPT code 19112, you should first verify its inclusion and the associated reimbursement rate in the MPFS. Additionally, check with your specific MAC to ensure there are no regional variations or additional documentation requirements that could affect reimbursement. By consulting both the MPFS and your MAC, you can determine if CPT code 19112 is reimbursed by Medicare and understand any specific conditions that may apply.
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