CPT code 19298 is for the placement of breast radiotherapy tubes or catheters.
CPT code 19298 is used to describe the procedure of placing a radiological tube or catheter into the breast. This is typically done for treatments such as delivering radiation therapy directly to the site of a tumor or for drainage purposes. The code ensures that the specific service of inserting these devices is accurately documented and billed.
When using CPT code 19298 for placing breast radiological tubes or catheters, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or unusual circumstances.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both breasts during the same session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that more than one procedure was carried out.
4. Modifier 52 - Reduced Services
- This modifier is used if the procedure was partially reduced or eliminated at the physician's discretion.
5. 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.
6. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used if the procedure was repeated by a different physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier if the patient had to return 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
- Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
10. Modifier LT - Left Side
- This modifier is used to specify that the procedure was performed on the left breast.
11. Modifier RT - Right Side
- Apply this modifier to indicate that the procedure was performed on the right breast.
12. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician
- Use this modifier if the procedure was performed in part by a resident under the supervision of a teaching physician.
13. Modifier QX - CRNA Service: With Medical Direction by a Physician
- This modifier is used if a Certified Registered Nurse Anesthetist (CRNA) performed the anesthesia service under the medical direction of a physician.
14. Modifier QY - Medical Direction of One CRNA by an Anesthesiologist
- Apply this modifier if an anesthesiologist provided medical direction for one CRNA.
15. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals
- Use this modifier if an anesthesiologist is directing two to four concurrent anesthesia procedures.
16. Modifier QS - Monitored Anesthesia Care Service
- This modifier is used to indicate that monitored anesthesia care (MAC) was provided.
17. Modifier G8 - Monitored Anesthesia Care (MAC) for Deep Complex, Complicated, or Markedly Invasive Surgical Procedure
- Apply this modifier if MAC was provided for a deep, complex, or markedly invasive surgical procedure.
18. Modifier G9 - Monitored Anesthesia Care for Patient Who Has a History of Severe Cardiopulmonary Condition
- Use this modifier if MAC was provided for a patient with a history of severe cardiopulmonary conditions.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and appropriate reimbursement.
CPT code 19298, which involves the placement of breast radiological tubes or catheters, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B.
Additionally, it is important to consult with the specific Medicare Administrative Contractor (MAC) for your region, as they are responsible for processing Medicare claims and can provide detailed information on coverage and reimbursement policies for CPT code 19298.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level and by individual payer. For instance, RevFind can identify discrepancies for specific codes like 19298. Schedule a demo today to see how RevFind can help you recover lost revenue and ensure you receive the payments you deserve.
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