CPT code 19330 is for the removal of a ruptured breast implant, a procedure often necessary for patient health and implant replacement.
CPT code 19330 is used to describe the procedure for the removal of a ruptured breast implant. This code is specifically utilized by healthcare providers to document and bill for the surgical removal of a breast implant that has ruptured, ensuring accurate and standardized reporting for insurance claims and medical records.
When billing for the removal of a ruptured breast implant using CPT code 19330, 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 if the procedure is performed on both breasts during the same surgical session.
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 removal of the ruptured implant is part of a staged procedure or related to the initial surgery.
4. Modifier 59 (Distinct Procedural Service): Indicates that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): Used if the same procedure is repeated by the same physician.
6. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Applied if the procedure is repeated by a different physician.
7. 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 if the patient returns to the operating room for a related procedure during the postoperative period.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Indicates that the procedure is unrelated to the original surgery and performed during the postoperative period.
9. Modifier 80 (Assistant Surgeon): Used if an assistant surgeon is required during the procedure.
10. Modifier 81 (Minimum Assistant Surgeon): Applied if a minimum assistant surgeon is required.
11. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
12. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Indicates that a non-physician provider assisted in the surgery.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement.
The CPT code 19330, which pertains to the removal of a ruptured breast implant, is reimbursed by Medicare under specific conditions. To determine if this code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) for the most current reimbursement rates and guidelines. Additionally, it is crucial to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as they provide specific local coverage determinations (LCDs) and policies that may affect reimbursement. Always ensure that the procedure meets the medical necessity criteria outlined by Medicare to qualify for reimbursement.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 19330. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and protect your revenue.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
