CPT code 19126 is for the excision of an additional breast lesion, typically used in surgical procedures to remove abnormal tissue.
CPT code 19126 is used to describe the procedure of excising an additional breast lesion. This means that during a surgical operation, after the initial breast lesion has been removed, this code is applied for the removal of any subsequent lesions in the breast. This code ensures that the healthcare provider is accurately reimbursed for the additional work involved in excising more than one lesion.
For CPT code 19126, which pertains to the excision of an additional breast lesion, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both breasts during the same operative session.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session.
3. Modifier 59 - Distinct Procedural Service: Indicates that the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: Used if the same procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician: Applied if the same procedure is repeated by a different physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used if the patient needs to return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that the procedure is unrelated to the original procedure and is performed during the postoperative period.
8. Modifier LT - Left Side: Used to specify that the procedure was performed on the left breast.
9. Modifier RT - Right Side: Used to specify that the procedure was performed on the right breast.
10. Modifier GC - This service has been performed in part by a resident under the direction of a teaching physician: Used in teaching settings where a resident is involved in the procedure under the supervision of a teaching physician.
11. Modifier QX - CRNA service with medical direction by a physician: Applied when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the medical direction of a physician.
12. Modifier QK - Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals: Used when a physician is directing multiple anesthesia procedures concurrently.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
When determining if CPT code 19126 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 payment rates used by Medicare to reimburse physicians and other healthcare providers for services rendered. Each MAC may have specific guidelines and coverage determinations that can affect reimbursement.
For CPT code 19126, you would first check the MPFS to see if the code is listed and what the reimbursement rate is. Additionally, it is crucial to review any Local Coverage Determinations (LCDs) or National Coverage Determinations (NCDs) issued by your MAC, as these documents provide detailed information on whether a particular service is covered and under what circumstances.
In summary, to determine if CPT code 19126 is reimbursed by Medicare, you need to reference the MPFS and consult the relevant MAC guidelines.
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