CPT code 19368 is for breast reconstruction using a single pedicle TRAM flap with microvascular anastomosis.
CPT code 19368 is used to describe a breast reconstruction procedure that involves a single pedicle transverse rectus abdominis myocutaneous (TRAM) flap with microvascular anastomosis. This means that tissue from the lower abdomen, including skin, fat, and muscle, is used to reconstruct the breast, and the blood vessels are reconnected using microsurgery techniques to ensure proper blood flow to the transplanted tissue.
For CPT code 19368, which pertains to breast reconstruction using a single pedicle TRAM flap with microvascular anastomosis, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required. For instance, if the reconstruction procedure is more complex due to patient-specific factors, this modifier may be appropriate.
2. Modifier 50 (Bilateral Procedure): If the procedure is performed on both breasts, this modifier should be used to indicate that the service was bilateral.
3. Modifier 51 (Multiple Procedures): When multiple procedures are performed during the same surgical session, this modifier is used to indicate that multiple distinct procedures were carried out.
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 particularly useful when the procedures are not typically reported together but are appropriate under the circumstances.
5. Modifier 62 (Two Surgeons): If two surgeons are required to perform distinct parts of the procedure, this modifier should be used to indicate the collaborative effort.
6. Modifier 76 (Repeat Procedure by Same Physician): If the same physician needs to repeat the procedure, this modifier is used to indicate that the procedure was repeated.
7. Modifier 77 (Repeat Procedure by Another Physician): If a different physician repeats the procedure, this modifier is used to indicate that the procedure was repeated by another 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): This modifier is used 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): If an unrelated procedure is performed by the same physician during the postoperative period, this modifier should be used.
10. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required to help with the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when a minimum assistant surgeon is required for the procedure.
12. 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.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each of these modifiers serves a specific purpose and should be used according to the specific circumstances of the procedure to ensure accurate billing and reimbursement.
The CPT code 19368 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 respective reimbursement rates.
Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing requirements that may affect reimbursement for CPT code 19368. Each MAC may have unique guidelines and policies that influence how this code is processed and reimbursed.
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