CPT code 19370 is for the revision of the peri-implant capsule of the breast, typically involving the removal or adjustment of scar tissue.
CPT code 19370 is used for the revision of the peri-implant capsule of the breast. This procedure involves the surgical correction or modification of the fibrous tissue capsule that forms around a breast implant. It is typically performed to address issues such as capsular contracture, where the capsule tightens and causes discomfort or changes in the appearance of the breast.
For CPT code 19370, which pertains to the revision of the peri-implant capsule of the breast, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 - Bilateral Procedure
- This modifier is used when the procedure is performed on both breasts during the same operative session.
3. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. This indicates that the procedure is one of several performed.
4. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure is distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used when the same procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier when the same procedure is repeated by a different physician on the same day.
7. 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 when the patient returns to the operating room for a related procedure during the postoperative period of the initial surgery.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier when the procedure is performed by the same physician during the postoperative period of another procedure, but the procedure is unrelated to the original surgery.
9. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required to help perform the procedure.
10. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier when a minimum assistant surgeon is required to assist with the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier 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 in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper use of modifiers ensures accurate billing and reimbursement for the services provided.
CPT code 19370, which refers to the revision of the peri-implant capsule of the breast, is reimbursed by Medicare under specific conditions. To determine if this code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare.
Additionally, it is crucial to consult the local Medicare Administrative Contractor (MAC) for any specific coverage guidelines or requirements that may apply to this procedure. The MACs are responsible for processing Medicare claims and can provide detailed information on whether CPT code 19370 is reimbursed in your specific region.
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 19370. Schedule a demo today to see how RevFind can help you identify and recover lost revenue from individual payers.
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