CPT code 19342 is for the insertion or replacement of a breast implant on a separate day.
CPT code 19342 is used to describe the procedure for the insertion or replacement of a breast implant on a separate day from the initial surgery. This code is typically utilized when a patient requires a new breast implant or needs to replace an existing one, and the procedure is performed independently of the original surgery. This could be due to various reasons such as complications, cosmetic adjustments, or other medical necessities.
For CPT code 19342, the following modifiers may be applicable:
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.
5. Modifier 77 - Repeat Procedure by Another Physician: Applied when the same procedure is repeated by a different physician.
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: Used when an unrelated procedure is performed by the same physician during the postoperative period.
8. Modifier LT - Left Side: Indicates that the procedure was performed on the left breast.
9. Modifier RT - Right Side: Indicates that the procedure was performed on the right breast.
10. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required.
11. Modifier 23 - Unusual Anesthesia: Applied when a procedure that usually requires either no anesthesia or local anesthesia must be performed under general anesthesia due to unusual circumstances.
12. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Used when an unrelated evaluation and management service is performed by the same physician during the postoperative period.
13. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Used when a significant, separately identifiable evaluation and management service is performed on the same day as the procedure.
14. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed.
15. Modifier 52 - Reduced Services: Applied when the service or procedure is partially reduced or eliminated at the physician's discretion.
16. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
17. Modifier 54 - Surgical Care Only: Indicates that only the surgical care portion of the service is being billed.
18. Modifier 55 - Postoperative Management Only: Used when only the postoperative management portion of the service is being billed.
19. Modifier 56 - Preoperative Management Only: Applied when only the preoperative management portion of the service is being billed.
20. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
21. Modifier 66 - Surgical Team: Applied when a team of surgeons is required to perform the procedure.
22. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
23. Modifier 81 - Minimum Assistant Surgeon: Applied when a minimum assistant surgeon is required during the procedure.
24. 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.
25. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these non-physician practitioners assist in surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 19342 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS) and consult with your Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including the associated reimbursement rates. Additionally, MACs can offer region-specific guidance and any potential variations in coverage or reimbursement criteria.
Always ensure to check the latest updates from both the MPFS and your MAC to confirm the current reimbursement status for CPT code 19342.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 19342, and by individual payer. Don't let underpayments slip through the cracks—schedule a demo today to see how RevFind can optimize your revenue cycle management.
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
