CPT code 19367 is for breast reconstruction using a single pedicle TRAM flap, a surgical procedure to rebuild the breast.
CPT code 19367 is for breast reconstruction using a single pedicle TRAM (Transverse Rectus Abdominis Myocutaneous) flap. This procedure involves using tissue from the patient's lower abdomen to reconstruct the breast. The "pedicle" refers to the fact that the tissue remains attached to its original blood supply during the transfer. This method is often chosen for its natural look and feel, as it uses the patient's own tissue.
For CPT code 19367, which pertains to breast reconstruction using a single pedicle TRAM flap, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to complications or additional work involved in the reconstruction.
2. Modifier 50 (Bilateral Procedure): Applied if the procedure 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 modifier indicates that the primary procedure is accompanied by additional procedures.
4. Modifier 52 (Reduced Services): Applied if the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 (Discontinued Procedure): Used if the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is used to identify procedures that are not typically reported together but are appropriate under the circumstances.
7. Modifier 62 (Two Surgeons): Applied when two surgeons work together as primary surgeons performing distinct parts of the procedure.
8. Modifier 66 (Surgical Team): Used when a highly complex procedure requires the skills of several surgeons, often from different specialties.
9. Modifier 76 (Repeat Procedure by Same Physician): Used if the same physician performs the procedure again within a short period.
10. Modifier 77 (Repeat Procedure by Another Physician): Applied if a different physician performs the repeat procedure.
11. 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 requires a return to the operating room for a related procedure during the postoperative period.
12. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Indicates that an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
13. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required for the procedure.
14. Modifier 81 (Minimum Assistant Surgeon): Applied when an assistant surgeon is required for a minimal portion of the procedure.
15. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is required, and a qualified resident surgeon is not available.
16. 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 19367, which is for a specific medical procedure, is reimbursed by Medicare. To determine the reimbursement rate, you can refer to the Medicare Physician Fee Schedule (MPFS), which provides detailed information on the payment rates for various services covered by Medicare.
Additionally, the reimbursement for this CPT code may vary slightly depending on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and setting local coverage determinations. Therefore, it is advisable to check with the specific MAC for your region to get precise information on the reimbursement rate for CPT code 19367.
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