CPT code 19304 is used for a subcutaneous mastectomy, a surgical procedure to remove breast tissue while preserving the skin and nipple.
CPT code 19304 is used to describe a subcutaneous mastectomy. This surgical procedure involves the removal of breast tissue while preserving the overlying skin, nipple, and areola. It is often performed for patients with conditions such as gynecomastia or for those seeking prophylactic measures against breast cancer.
Certainly! Here are the modifiers that could be used with CPT code 19304:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 - Bilateral Procedure
- This modifier is used when the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
4. Modifier 52 - Reduced Services
- Use this modifier when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure
- This modifier is used when a procedure is 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 a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 62 - Two Surgeons
- Use this modifier when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
8. Modifier 66 - Surgical Team
- This modifier is used when a highly complex procedure is carried out by a surgical team.
9. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Apply this modifier when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
10. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Use this modifier when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
11. 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
- This modifier is used when a patient returns to the operating room for a related procedure during the postoperative period.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
- Apply this modifier when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
13. Modifier 80 - Assistant Surgeon
- Use this modifier when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- This modifier is used when a minimum assistant surgeon is required during the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier when an assistant surgeon is required, and a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
These modifiers help provide additional information about the performed procedure, ensuring accurate billing and appropriate reimbursement.
The CPT code 19304 is not reimbursed by Medicare. According to the Medicare Physician Fee Schedule (MPFS), this specific code is not listed, indicating that it is not covered under Medicare's reimbursement policies.
Additionally, Medicare Administrative Contractors (MACs) do not provide reimbursement for this code, further confirming its non-reimbursable status under Medicare guidelines.
Healthcare providers should verify with their local MAC for any updates or specific regional policies, but as of the current guidelines, CPT code 19304 is not eligible for Medicare reimbursement.
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