CPT code 19240 is for the surgical removal of a breast, typically performed to treat or prevent breast cancer.
CPT code 19240 is used to describe the surgical procedure for the removal of a breast. This code is typically utilized in medical billing to indicate that a mastectomy, which is the complete removal of breast tissue, has been performed. This procedure is often necessary for patients diagnosed with breast cancer or other severe breast conditions.
When billing for the CPT code 19240, which pertains to the removal of the breast, the following modifiers may be applicable depending on the specific circumstances of the procedure:
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: Used to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier 62 - Two Surgeons: Applied when two surgeons work together as primary surgeons performing distinct parts of the procedure.
5. Modifier 66 - Surgical Team: Used when a team of surgeons is required to perform the procedure.
6. Modifier 76 - Repeat Procedure by Same Physician: Applied if the same physician repeats the procedure on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Used if a different physician repeats the procedure on the same day.
8. Modifier 78 - Unplanned Return to the Operating Room: Applied if the patient returns to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used if an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Applied when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Applied when an assistant surgeon is required because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement.
The CPT code 19240 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare, including CPT code 19240. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and reimbursement policies for this code. Providers should consult their respective MACs to understand any regional variations or additional requirements that may apply to the reimbursement of CPT code 19240.
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