CPT code 19303 is for a complete simple mastectomy, a surgical procedure to remove all breast tissue.
CPT code 19303 is used to describe a simple, complete mastectomy. This procedure involves the surgical removal of the entire breast, including the nipple, areola, and most of the overlying skin, but does not typically involve the removal of lymph nodes or muscle tissue beneath the breast. This code is essential for accurate billing and documentation in the healthcare revenue cycle, ensuring that providers are reimbursed appropriately for the services rendered.
For CPT code 19303, which pertains to a mastectomy, simple, complete, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Used when 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: Indicates that the procedure is distinct or independent from other services performed on the same day.
4. Modifier LT - Left Side: Used to specify that the procedure was performed on the left breast.
5. Modifier RT - Right Side: Used to specify that the procedure was performed on the right breast.
6. Modifier 22 - Increased Procedural Services: Applied when the work required to perform the procedure is substantially greater than typically required.
7. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of the procedure.
8. Modifier 80 - Assistant Surgeon: Indicates that an assistant surgeon was required for the procedure.
9. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon is required for a portion of the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Applied when an assistant surgeon is necessary because a qualified resident surgeon is not available.
11. 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.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 19303 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for CPT code 19303. It is essential for healthcare providers to consult both the MPFS and their respective MACs to ensure compliance with Medicare's billing and reimbursement requirements for this specific code.
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