CPT code 19324 is a medical code used to describe the procedure for enlarging the breast.
CPT code 19324 is used to describe a surgical procedure for the enlargement of the breast. This code is typically utilized when a patient undergoes breast augmentation, which involves the insertion of implants or the use of other techniques to increase the size and improve the shape of the breasts. This procedure is often performed for cosmetic reasons but can also be part of reconstructive surgery following mastectomy or other medical conditions.
When using CPT code 19324 for breast enlargement, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
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
- Used to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician
- Applied when the same procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician
- Used when the same procedure is repeated by a different physician on the same day.
6. 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.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
8. Modifier 80 - Assistant Surgeon
- Applied when an assistant surgeon is required during the procedure.
9. Modifier 81 - Minimum Assistant Surgeon
- Used when a minimum assistant surgeon is required during the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Applied when an assistant surgeon is required 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 a non-physician provider assists in the surgery.
12. Modifier LT - Left Side
- Applied when the procedure is performed on the left breast.
13. Modifier RT - Right Side
- Used when the procedure is performed on the right breast.
14. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician
- Applied when a resident performs part of the procedure under the supervision of a teaching physician.
15. Modifier QX - CRNA Service: with Medical Direction by a Physician
- Used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the direction of a physician.
16. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals
- Applied when a physician directs multiple anesthesia procedures concurrently.
Each modifier provides specific information that can affect reimbursement and documentation requirements, so it is crucial to select the appropriate modifier based on the clinical scenario.
When determining if CPT code 19324 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various services, and it is updated annually.
For CPT code 19324, you would need to verify its status on the MPFS to see if it is listed and whether it has an assigned reimbursement rate. Additionally, MACs, which are private health care insurers that have been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims, may have specific local coverage determinations (LCDs) that affect the reimbursement of this code.
Therefore, to determine if CPT code 19324 is reimbursed by Medicare, you should review the MPFS and consult the relevant MAC's guidelines. This will provide the most accurate and up-to-date information regarding the reimbursement status of this specific CPT code.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 19324. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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