CPT code 19271 is for the surgical revision of the chest wall, often performed to correct or improve previous procedures.
CPT code 19271 is used to describe the surgical procedure for the revision of the chest wall. This involves the correction or modification of a previous chest wall surgery, which may be necessary due to complications, deformities, or other issues that have arisen since the initial procedure. This code ensures that the healthcare provider is accurately reimbursed for the complexity and expertise required to perform this corrective surgery.
When billing for CPT code 19271, "Revision of chest wall," the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort or complexity than typically required.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both sides of the chest wall.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure
- Use this modifier if the procedure was started but 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 the procedure was distinct or independent from other services performed on the same day.
7. Modifier 62 - Two Surgeons
- Use this modifier if two surgeons worked together as primary surgeons performing distinct parts of the procedure.
8. Modifier 66 - Surgical Team
- Apply this modifier if the procedure required the services of a surgical team.
9. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician performed the procedure more than once on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if a different physician performed the procedure more than once 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
- Use this modifier if the patient required an unplanned return to the operating room for a related procedure during the postoperative period.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if the procedure was unrelated to the original procedure and performed during the postoperative period.
13. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required for the procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required for the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was necessary because a qualified resident surgeon was not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
The CPT code 19271 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. To determine the exact reimbursement rate and any additional requirements, healthcare providers should consult the MPFS.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and providing guidance on Medicare coverage policies. Each MAC may have specific local coverage determinations (LCDs) that could affect the reimbursement of CPT code 19271. Therefore, it is essential for healthcare providers to verify the details with their respective MAC to ensure compliance and accurate reimbursement.
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