CPT code 19364 is a medical billing code for breast reconstruction using a free flap technique.
CPT code 19364 is used for breast reconstruction using a free flap. This procedure involves transferring tissue from one part of the body, such as the abdomen or buttocks, to the chest to reconstruct the breast. The term "free flap" indicates that the tissue is completely detached from its original blood supply and reattached to blood vessels in the chest area. This complex surgery is often performed after a mastectomy to restore the breast's appearance and is considered a highly specialized technique in reconstructive surgery.
For CPT code 19364 (Breast reconstruction with free flap), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as increased intensity, time, technical difficulty, or physical and mental effort.
2. Modifier 50 - Bilateral Procedure: Apply this modifier if the procedure was performed on both breasts during the same operative session.
3. Modifier 51 - Multiple Procedures: Use this modifier when multiple procedures are performed during the same surgical session. This indicates that the primary procedure was accompanied by additional procedures.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is typically used to identify procedures that are not normally reported together but are appropriate under the circumstances.
5. Modifier 62 - Two Surgeons: Apply this modifier when two surgeons work together as primary surgeons performing distinct parts of the procedure.
6. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same physician needs to repeat the procedure on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated by a different physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Use this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Apply this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon: Use this modifier when an assistant surgeon is required to help with the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required for a minimal portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Apply this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier when a non-physician provider assists 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 19364, which refers to a specific medical procedure, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for various services covered by Medicare. Additionally, it is important to consult with your local Medicare Administrative Contractor (MAC) for any region-specific guidelines or variations in reimbursement policies. The MACs are responsible for processing Medicare claims and can provide further clarification on coverage and payment for CPT code 19364.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 19364. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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