CPT code 19306 is a medical billing code used to describe a mastectomy procedure of the radical urban type.
CPT code 19306 is for a "Mastectomy, radical, urban type." 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 is typically performed to treat or prevent the spread of breast cancer. The term "urban type" refers to a specific technique or approach used during the surgery.
When billing for the CPT code 19306, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: Used if 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 52 - Reduced Services: Used if the procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Applied if the 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 62 - Two Surgeons: Applied when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
7. Modifier 66 - Surgical Team: Used when a highly complex procedure is carried out by a surgical team.
8. Modifier 76 - Repeat Procedure by Same Physician: Applied if the same procedure is repeated by the same physician.
9. Modifier 77 - Repeat Procedure by Another Physician: Used if the same procedure is repeated by a different physician.
10. 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 when the patient returns to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used if an unrelated procedure is performed by the same physician during the postoperative period.
12. Modifier 80 - Assistant Surgeon: Applied when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required.
14. 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.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these professionals assist in the surgery.
Each modifier serves a specific purpose and should be used accurately to ensure proper billing and reimbursement.
The CPT code 19306 is reimbursed by Medicare, but the reimbursement is subject to the guidelines and rates set forth in the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals to Medicare beneficiaries.
Additionally, the specific reimbursement for CPT code 19306 may vary depending on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and determining local coverage and payment policies.
Therefore, it is essential to consult the relevant MAC for detailed information on the reimbursement rate and any specific requirements or limitations that may apply.
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