CPT code 19307 is for a modified radical mastectomy, a surgical procedure to remove breast tissue and lymph nodes.
CPT code 19307 is for a "Mastectomy, modified radical." This procedure involves the surgical removal of the entire breast, including the breast tissue, skin, and often the nipple and areola. Additionally, it typically includes the removal of some of the lymph nodes under the arm (axillary lymph nodes) but spares the chest muscles. This type of mastectomy is commonly performed to treat or prevent the spread of breast cancer.
When billing for the CPT code 19307, which pertains to a specific surgical procedure, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Used 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
- Applied when the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures
- Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
4. Modifier 52 - Reduced Services
- Used when the procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reason for the reduction.
5. Modifier 53 - Discontinued Procedure
- Applied when the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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. This modifier is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
7. Modifier 62 - Two Surgeons
- Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
8. Modifier 66 - Surgical Team
- Applied when a highly complex procedure is carried out by a surgical team.
9. Modifier 76 - Repeat Procedure by Same Physician
- Used when the same physician performs a procedure or service again on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician
- Applied when a procedure or service is repeated by another physician on the same day.
11. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Used when a related procedure is performed during the postoperative period of the initial procedure.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Applied when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
13. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required for the procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- Applied when a minimum assistant surgeon is required for the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Used 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
- Applied when a non-physician practitioner assists in the surgery.
Each modifier serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Documentation should always support the use of any modifier to avoid claim denials or audits.
The CPT code 19307 is reimbursed by Medicare, but the reimbursement is subject to several factors.
The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 19307.
However, the actual reimbursement can vary based on the geographic location and specific policies of the Medicare Administrative Contractor (MAC) that processes claims in your region.
It is essential to consult the MPFS and your local MAC guidelines to determine the exact reimbursement rate and any additional requirements for CPT code 19307.
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