CPT code 19357 is for the placement of a tissue expander in breast reconstruction.
CPT code 19357 is used for the placement of a tissue expander in breast reconstruction. This procedure typically follows a mastectomy and involves inserting a balloon-like device under the skin and chest muscle. The expander is gradually filled with saline over time to stretch the skin and create space for a future breast implant. This code is essential for documenting and billing the initial step in the breast reconstruction process.
For CPT code 19357, which pertains to tissue expander placement for 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 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 repeats the procedure on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: Applied when a different physician repeats the procedure on the same day.
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 when 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: Applied when an unrelated procedure is performed by the same physician during the postoperative period.
9. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Applied when a minimum assistant surgeon is required for the procedure.
11. 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.
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.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 19357, which involves a specific medical procedure, is subject to reimbursement by Medicare. To determine if this code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare. Additionally, it is essential to consult with the Medicare Administrative Contractor (MAC) for your specific region, as they are responsible for processing Medicare claims and can provide guidance on coverage and reimbursement specifics for CPT code 19357. The MAC will have the most up-to-date information on whether this code is reimbursed and any particular documentation or billing requirements that must be met.
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