CPT code 19350 is used for breast reconstruction procedures, detailing the specific surgical techniques involved in rebuilding the breast.
CPT code 19350 is used for breast reconstruction procedures. This code specifically refers to the surgical process of reconstructing the breast, which may be necessary after a mastectomy or other breast surgery. The procedure aims to restore the breast's shape, appearance, and size, often involving the use of implants or tissue from other parts of the patient's body. This code is essential for healthcare providers to accurately document and bill for the breast reconstruction services they provide.
For CPT code 19350 (Breast reconstruction), 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 breast reconstruction procedure is distinct or independent from other services performed on the same day.
4. Modifier 62 - Two Surgeons: Applied when two surgeons work together as primary surgeons performing distinct parts of the procedure.
5. Modifier 76 - Repeat Procedure by Same Physician: Used if the same physician needs to repeat the breast reconstruction procedure.
6. Modifier 77 - Repeat Procedure by Another Physician: Applied if a different physician repeats the breast reconstruction procedure.
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 needs to return 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: Applied when an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.
9. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the breast reconstruction procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Applied when a minimum assistant surgeon is required during the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Applied when these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement for the breast reconstruction procedure.
The CPT code 19350 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and reimbursement policies for CPT code 19350. It is essential for healthcare providers to consult both the MPFS and their respective MAC guidelines to ensure compliance and accurate reimbursement for this procedure.
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