CPT code 19305 is for a radical mastectomy, a surgical procedure involving the removal of the breast, underlying chest muscle, and lymph nodes.
CPT code 19305 is used to describe a "Mastectomy, radical." This procedure involves the surgical removal of the entire breast, including the breast tissue, skin, nipple, areola, and most of the underarm lymph nodes. It may also involve the removal of the chest wall muscles under the breast. This type of mastectomy is typically performed to treat or prevent the spread of breast cancer.
For CPT code 19305, which pertains to a specific surgical procedure, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Used when the procedure is performed on both sides of the body.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Used if the procedure is planned or staged.
4. Modifier 59 - Distinct Procedural Service: Indicates that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
6. Modifier 66 - Surgical Team: Applied when a team of surgeons is required to perform the procedure.
7. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used if the procedure is repeated by the same provider.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used if the procedure is repeated by a different provider.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Applied if the patient needs to return to the operating room unexpectedly.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed during the postoperative period of the initial procedure.
11. Modifier 80 - Assistant Surgeon: Indicates that an assistant surgeon was necessary for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon is required for a minimal portion of the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Applied when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these non-physician providers assist in the surgery.
Each modifier serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 19305 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, including the associated payment rates.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) have the authority to make local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your geographic area to confirm the specific reimbursement policies and rates for CPT code 19305.
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