CPT code 19355 is used for the surgical correction of inverted nipples, a procedure to improve nipple appearance and function.
CPT code 19355 is used to describe the surgical procedure for correcting inverted nipples. This procedure involves techniques to release the fibrous bands or ducts that are causing the nipple to be pulled inward, allowing it to project outward normally. This code is typically used by plastic surgeons or other healthcare providers specializing in breast surgery to ensure accurate billing and documentation for this specific corrective procedure.
When billing for the procedure associated with CPT code 19355, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body. For instance, if both nipples are corrected in the same session, this modifier should be appended.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was carried out.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It is particularly useful if the procedure is not typically reported together with other services but is appropriate under the circumstances.
4. Modifier LT - Left Side: This modifier is used to specify that the procedure was performed on the left side of the body.
5. Modifier RT - Right Side: This modifier is used to specify that the procedure was performed on the right side of the body.
6. Modifier 22 - Increased Procedural Services: If the procedure required significantly more work than usual, this modifier can be used to indicate the additional effort and complexity involved.
7. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure, this modifier indicates that both surgeons are equally responsible for the procedure.
8. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help with the procedure.
9. Modifier 81 - Minimum Assistant Surgeon: This modifier indicates that an assistant surgeon was required for a minimal portion of the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
These modifiers help provide additional information about the procedure and ensure accurate billing and reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
The CPT code 19355, which is used for the procedure to correct inverted nipple(s), is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B.
Additionally, it is important to consult with the specific Medicare Administrative Contractor (MAC) for your region, as they administer Medicare claims and can provide detailed information on coverage and reimbursement policies for CPT code 19355.
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