CPT code 19288 is for the placement of a breast localization device, such as a clip, under MRI guidance, used in surgical planning.
CPT code 19288 is used to describe the procedure of placing a percutaneous device in the breast under MRI guidance. This code is typically used when an additional device is needed during a breast biopsy or other breast-related procedures to ensure precise placement and accurate targeting of the area of concern. The use of MRI guidance helps in providing detailed images, which aids the healthcare provider in performing the procedure with greater accuracy.
Certainly! Here are the modifiers that could be used with CPT code 19288:
1. Modifier 22 - Increased Procedural Services
- Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 26 - Professional Component
- Used when only the professional component of the service is being billed.
3. Modifier 52 - Reduced Services
- Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure
- Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service
- Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
- Used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
- Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Used when a minimum assistant surgeon is required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Used when an assistant surgeon is required and a qualified resident surgeon is not available.
13. Modifier 99 - Multiple Modifiers
- Used when two or more modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the performed procedure, ensuring accurate billing and appropriate reimbursement.
Determining whether CPT code 19288 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, while the MACs are responsible for interpreting national policies into local coverage determinations.
To ascertain if CPT code 19288 is reimbursed, you would first need to check the MPFS to see if the code is listed and if it has an assigned reimbursement rate. If the code is present in the MPFS, it generally indicates that Medicare provides reimbursement for that service. However, the final determination often depends on the MAC's local coverage policies, which may have additional criteria or restrictions.
Therefore, to confirm if CPT code 19288 is reimbursed by Medicare, you should review both the MPFS and the specific guidelines issued by your regional MAC.
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