CPT code 19380 is used for the revision of a reconstructed breast, typically involving adjustments or corrections to a previous breast reconstruction.
CPT code 19380 is used to describe the surgical procedure for the revision of a reconstructed breast. This code is typically utilized when a patient who has previously undergone breast reconstruction surgery requires additional surgical adjustments or corrections to improve the aesthetic outcome or address complications. The revision may involve reshaping the breast, adjusting the position of implants, or correcting asymmetries to achieve the desired appearance and functionality.
When billing for CPT code 19380, which pertains to revision of a reconstructed breast, it is essential to consider the appropriate modifiers to ensure accurate reimbursement and compliance. Below is a list of potential modifiers that could be used with CPT code 19380, along with the reasons for their use:
1. Modifier 50 (Bilateral Procedure):
- Used when the procedure is performed on both breasts during the same operative session.
2. Modifier 51 (Multiple Procedures):
- Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
3. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period):
- Used if the revision is part of a planned or staged procedure following the initial reconstruction.
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 issues.
5. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional):
- Applied when the same procedure is repeated by the same provider.
6. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional):
- Used when the procedure is repeated by a different provider.
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 an unplanned return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period):
- Used when the procedure is unrelated to the original surgery and occurs during the postoperative period.
9. Modifier LT (Left Side):
- Indicates that the procedure was performed on the left breast.
10. Modifier RT (Right Side):
- Indicates that the procedure was performed on the right breast.
11. Modifier 22 (Increased Procedural Services):
- Used when the work required to perform the procedure is substantially greater than typically required.
12. Modifier 23 (Unusual Anesthesia):
- Applied when a procedure that usually requires no anesthesia or local anesthesia must be performed under general anesthesia due to unusual circumstances.
Each of these modifiers serves a specific purpose and should be used accurately to reflect the circumstances of the procedure, ensuring proper billing and reimbursement.
The CPT code 19380 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and consult with your regional Medicare Administrative Contractor (MAC).
The MPFS provides detailed information on the reimbursement rates and guidelines for various CPT codes, including 19380. Additionally, MACs can offer region-specific insights and any additional requirements or documentation needed for successful reimbursement.
Always ensure to stay updated with the latest guidelines from both the MPFS and your MAC to optimize your revenue cycle management.
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