CPT code 19160 is for a partial mastectomy, a surgical procedure to remove part of the breast tissue, often used in breast cancer treatment.
CPT code 19160 is used to describe a partial mastectomy procedure. This surgical operation involves the removal of a portion of breast tissue, typically to excise a tumor or abnormal growth while preserving as much of the breast as possible. The goal of a partial mastectomy is to treat or prevent breast cancer while maintaining the breast's appearance and function.
For CPT code 19160 (Partial mastectomy), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 - Bilateral Procedure
- This modifier is used when the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. This helps indicate that more than one procedure was carried out.
4. Modifier 52 - Reduced Services
- Use this modifier when the procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reason for the reduction.
5. Modifier 53 - Discontinued Procedure
- This modifier is used when the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
7. Modifier 62 - Two Surgeons
- Use this modifier when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
8. Modifier 66 - Surgical Team
- This modifier is used when a team of surgeons (more than two) is required to perform the procedure.
9. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier when the same physician performs a procedure or service again on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier when a procedure or service is repeated by another physician on the same day.
11. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- This modifier is used when the patient returns to the operating room for a related procedure during the postoperative period of the initial surgery.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
13. Modifier 80 - Assistant Surgeon
- Use this modifier when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- This modifier is used when a minimum assistant surgeon is required during the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier when an assistant surgeon is required, and a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Proper documentation is crucial to support the use of any modifier.
The CPT code 19160 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS).
The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and reimbursement policies for CPT code 19160.
It is essential for healthcare providers to consult both the MPFS and their respective MAC to ensure compliance with Medicare's billing and reimbursement requirements for this particular code.
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