CPT code 19340 is for the insertion of a breast implant following a simple mastectomy, a procedure often performed for breast reconstruction.
CPT code 19340 is used to describe the insertion of a breast implant following a simple mastectomy. This procedure typically involves placing a breast implant to reconstruct the breast after the removal of breast tissue due to cancer or other medical conditions. The code specifically indicates that the implant is inserted after a mastectomy that did not involve the removal of lymph nodes or muscle tissue.
When using CPT code 19340 for the insertion of a breast implant following a submuscular dissection, 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
- Used when the same procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician
- Applied 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
- Used 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
- Applied when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
8. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required for the procedure.
9. Modifier 81 - Minimum Assistant Surgeon
- Applied when a minimum assistant surgeon is required for the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Used 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
- Applied when a non-physician provider assists in the surgery.
12. Modifier LT - Left Side
- Used to indicate that the procedure was performed on the left breast.
13. Modifier RT - Right Side
- Used to indicate that the procedure was 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 medical direction of a physician.
16. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals
- Applied when a physician provides medical direction for multiple anesthesia procedures.
17. Modifier QS - Monitored Anesthesia Care Service
- Used to indicate that monitored anesthesia care was provided during the procedure.
18. Modifier G8 - Monitored Anesthesia Care (MAC) for Deep Complex, Complicated, or Markedly Invasive Surgical Procedure
- Applied when monitored anesthesia care is provided for a particularly complex or invasive procedure.
19. Modifier G9 - Monitored Anesthesia Care for Patient Who Has History of Severe Cardiopulmonary Condition
- Used when monitored anesthesia care is provided for a patient with a severe cardiopulmonary condition.
These modifiers help provide additional context and specificity to the billing and coding process, ensuring accurate reimbursement and compliance with payer requirements.
Determining whether CPT code 19340 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services covered by Medicare and their respective reimbursement rates.
To verify if CPT code 19340 is reimbursed, you would need to:
1. Check the MPFS: Access the Medicare Physician Fee Schedule database and search for CPT code 19340. This will provide information on whether the code is covered and the associated reimbursement rate if it is.
2. Consult Your MAC: Medicare Administrative Contractors are responsible for processing Medicare claims and can provide region-specific information regarding coverage. Each MAC may have different guidelines or additional requirements for reimbursement.
By cross-referencing both the MPFS and your regional MAC's guidelines, you can determine if CPT code 19340 is reimbursed by Medicare.
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