CPT code 19366 is used for breast reconstruction procedures, detailing the specific surgical techniques involved in rebuilding the breast.
CPT code 19366 is used for breast reconstruction. This code specifically refers to the surgical procedure where a breast is reconstructed, often following a mastectomy. The process involves creating a new breast shape using various techniques, which may include 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 reconstructive surgery, ensuring proper reimbursement and tracking of the medical service provided.
For CPT code 19366 (Breast reconstruction), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could apply if the breast reconstruction procedure is more complex due to patient-specific factors.
2. Modifier 50 - Bilateral Procedure: Used if the breast reconstruction is performed on both breasts during the same operative session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This could be applicable if breast reconstruction is performed along with other surgical procedures.
4. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Used if the breast reconstruction is part of a planned series of surgeries.
5. 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.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used if the breast reconstruction procedure needs to be repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used if the breast reconstruction procedure needs to be repeated by a different provider.
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: Used if the patient requires an unplanned 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: Used if the breast reconstruction is performed during the postoperative period of another, unrelated procedure.
10. Modifier 80 - Assistant Surgeon: Used if an assistant surgeon is required during the breast reconstruction procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used if a minimum assistant surgeon is required during the breast reconstruction procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used if an assistant surgeon is required and a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used if a non-physician provider assists 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 19366 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment rates.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have different local coverage determinations and payment policies. Therefore, it is advisable to consult the relevant MAC for your area to confirm the exact reimbursement details for CPT code 19366.
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