CPT code 19371 is for the removal of a breast implant capsule, a procedure often performed to address complications or improve implant results.
CPT code 19371 is used to describe the surgical procedure for the complete removal of the capsule around a breast implant. This procedure, known as a capsulectomy, is typically performed to address complications such as capsular contracture, where the scar tissue around the implant becomes tight and painful. The code specifically indicates that the entire capsule is being removed, which can help alleviate symptoms and improve the overall outcome for the patient.
For CPT code 19371, which pertains to peri-implant capsulotomy of the breast for complications, 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 other factors that increase the complexity of the surgery.
2. Modifier 50 (Bilateral Procedure): Applied when 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 helps indicate that the procedure is one of several performed.
4. Modifier 59 (Distinct Procedural Service): Indicates that the procedure is distinct or independent from other services performed on the same day. This is used to avoid bundling of services that are typically considered inclusive.
5. Modifier 76 (Repeat Procedure by Same Physician): Applied when the same procedure is repeated by the same physician on the same day.
6. Modifier 77 (Repeat Procedure by Another Physician): Used 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): Indicates that the patient required a return 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): Used when the procedure is performed by the same physician during the postoperative period of another, unrelated procedure.
9. Modifier 80 (Assistant Surgeon): Indicates that an assistant surgeon was required for the procedure.
10. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required for the procedure.
11. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Applied when an assistant surgeon is necessary because a qualified resident surgeon is not available.
12. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Indicates that a non-physician provider assisted in the surgery.
These modifiers help provide additional context and detail about the procedure, ensuring accurate billing and reimbursement.
CPT code 19371, which involves peri-implant capsulotomy of the breast, is reimbursed by Medicare, but it is subject to specific guidelines and conditions. To determine if this code is reimbursed under the Medicare Physician Fee Schedule (MPFS), healthcare providers should consult the MPFS database, which outlines the payment rates and coverage policies for various CPT codes.
Additionally, it is essential to verify with the local Medicare Administrative Contractor (MAC) as they may have specific local coverage determinations (LCDs) or additional documentation requirements that could affect reimbursement. Each MAC can have different interpretations and guidelines, so checking with the appropriate MAC is crucial for ensuring compliance and proper reimbursement for CPT code 19371.
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 19371. Schedule a demo today to see how RevFind can help you identify and recover every dollar you're owed from each payer.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
