CPT code 19220 is a medical code used to describe the procedure for the removal of a breast.
CPT code 19220 is used to describe the surgical procedure for the removal of a breast. This code is typically utilized in cases where a mastectomy is performed, which may be necessary due to conditions such as breast cancer or other serious breast diseases. The procedure involves the complete removal of breast tissue and is a critical component of treatment plans aimed at eliminating or reducing the risk of disease progression.
When billing for the CPT code 19220, which pertains to the removal of breast tissue, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: This modifier is used when the procedure is performed on both breasts during the same surgical session.
2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the removal of breast tissue is one of several procedures performed.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the removal of breast tissue is a distinct procedure from other services provided on the same day.
4. Modifier LT - Left Side: This modifier is used to specify that the procedure was performed on the left breast.
5. Modifier RT - Right Side: This modifier is used to specify that the procedure was performed on the right breast.
6. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required.
7. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of the procedure.
8. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help with the procedure.
9. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon provides minimal assistance during the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: This modifier is used when a non-physician provider assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 19220 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including their reimbursement rates. Additionally, MACs may have specific guidelines or requirements for reimbursement, so it is advisable to consult with your local MAC to ensure compliance and accurate billing.
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