CPT code 19369 is for breast reconstruction using a pedicled TRAM flap, a surgical procedure to rebuild the breast after mastectomy.
CPT code 19369 is for breast reconstruction using a pedicle TRAM flap. This procedure involves reconstructing the breast by using tissue from the patient's own lower abdomen, which remains attached to its original blood supply (pedicle) and is tunneled under the skin to the chest area. This method helps create a new breast mound following mastectomy.
Certainly! Here are the modifiers that could be used with CPT code 19369:
1. Modifier 22 (Increased Procedural Services)
- Used when the work required to provide a service is substantially greater than typically required. This could be due to factors such as increased intensity, time, technical difficulty, severity of the patient's condition, or physical and mental effort required.
2. Modifier 50 (Bilateral Procedure)
- Used when the procedure is performed on both sides of the body 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 procedure is one of several performed.
4. Modifier 52 (Reduced Services)
- Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 (Discontinued Procedure)
- Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 (Distinct Procedural Service)
- Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This modifier is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
7. Modifier 62 (Two Surgeons)
- Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
8. Modifier 66 (Surgical Team)
- Used when a team of surgeons (more than two) is required to perform a specific procedure.
9. Modifier 76 (Repeat Procedure by Same Physician)
- Used when the same physician performs a procedure or service more than once on the same day.
10. Modifier 77 (Repeat Procedure by Another Physician)
- Used when a procedure or service is repeated by another physician on the same day.
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 a related procedure is performed during the postoperative period of the initial procedure.
12. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period)
- Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
13. Modifier 80 (Assistant Surgeon)
- Used when an assistant surgeon is required during the procedure.
14. Modifier 81 (Minimum Assistant Surgeon)
- Used when a minimum assistant surgeon is required during 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)
- Used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 19369, 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), which outlines the payment rates for various services covered by Medicare.
Additionally, the reimbursement specifics can vary based on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and setting local coverage determinations. Therefore, it is advisable to consult the relevant MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 19369.
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