CPT code 19180 is a medical billing code used to describe the surgical removal of a breast.
CPT code 19180 is used to describe the surgical procedure for the removal of a breast. This code is typically utilized when a mastectomy is performed, which involves the complete removal of breast tissue, often as a treatment for breast cancer or other serious breast conditions. The procedure may be necessary to prevent the spread of disease or to alleviate symptoms associated with breast pathology.
When billing for the CPT code 19180 (Removal of breast), the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure
- Used when 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. This modifier indicates that the removal of the breast is one of several procedures.
3. Modifier 59 - Distinct Procedural Service
- Used to indicate that the removal of the breast is a distinct service from other procedures performed on the same day. This modifier helps to avoid bundling issues.
4. Modifier 62 - Two Surgeons
- Applied when two surgeons work together as primary surgeons performing distinct parts of the procedure.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Used if the same procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Applied when the same procedure is repeated by a different physician on the same day.
7. 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.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Applied when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
10. Modifier LT - Left Side
- Indicates that the procedure was performed on the left breast.
11. Modifier RT - Right Side
- Indicates 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 19180 is reimbursed by Medicare, but the reimbursement is subject to specific guidelines and conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services and procedures covered by Medicare, including CPT code 19180. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and reimbursement policies for this code. It is essential for healthcare providers to consult the MPFS and their respective MACs to understand the exact reimbursement rates and any additional requirements or documentation needed for CPT code 19180.
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