CPT code 19120 is for the surgical removal of a breast lesion, typically performed to diagnose or treat breast abnormalities.
CPT code 19120 is used to describe the surgical procedure for the removal of a breast lesion. This code is specifically assigned to indicate that a healthcare provider has performed an excision to remove a lump or abnormal tissue from the breast. This procedure is typically done to diagnose or treat a potential breast condition, such as a benign tumor or a suspicious mass that may require further pathological examination.
For CPT code 19120, "Removal of breast lesion," the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both breasts during the same operative session.
3. Modifier 51 - Multiple Procedures: Use this modifier if multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Use this modifier if the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Use this modifier if the procedure is 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 a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated by the same physician or other qualified healthcare professional.
8. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the procedure is repeated by a different physician or other qualified healthcare professional.
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: Use this modifier if the patient requires a 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: Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period.
11. Modifier LT - Left Side: Use this modifier to indicate that the procedure was performed on the left breast.
12. Modifier RT - Right Side: Use this modifier to indicate that the procedure was performed on the right breast.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 19120 is reimbursed by Medicare, but the reimbursement amount can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 19120. To determine the exact reimbursement rate for this code, healthcare providers should refer to the MPFS, which is updated annually.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and determining local coverage decisions. Each MAC may have specific guidelines and reimbursement rates for CPT code 19120, so it is essential for providers to consult their respective MAC for precise information. This ensures that they are compliant with local policies and receive accurate reimbursement for the services rendered.
Discover how MD Clarity's RevFind software can read your contracts and detect underpayments down to the CPT code level and by individual payer. With RevFind, you can identify discrepancies for specific procedures like CPT code 19120, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
