CPT code 19396 is for the design and creation of a custom breast implant, typically used in reconstructive or cosmetic breast surgery.
CPT code 19396 is used to describe the procedure for designing a custom breast implant. This code is typically utilized when a patient requires a breast implant that is tailored to their specific anatomical needs, often due to reconstructive surgery following mastectomy or other medical conditions. The process involves creating a unique implant that fits the patient's body precisely, ensuring optimal aesthetic and functional outcomes.
When using CPT code 19396 for the design of a custom breast implant, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the work required to design the custom breast implant is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the custom breast implant design is performed on both breasts during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier if the custom breast implant design is performed in conjunction with other procedures during the same operative session.
4. Modifier 52 - Reduced Services
- This modifier is applicable if the custom breast implant design service was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the custom breast implant design is a distinct service from other procedures performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the custom breast implant design procedure needs to be repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the custom breast implant design procedure is repeated by a different physician.
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 applicable 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
- Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon is required during the custom breast implant design procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon is required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is applicable if an assistant surgeon is required because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if 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 appropriately to ensure accurate billing and reimbursement for the custom breast implant design procedure.
CPT code 19396, which involves the design of a custom breast implant, is reimbursed by Medicare under specific conditions. To determine if this particular CPT code is covered, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services and procedures covered by Medicare. Additionally, it is crucial to consult the local Medicare Administrative Contractor (MAC) for region-specific guidelines and coverage determinations. The MACs are responsible for processing Medicare claims and can provide detailed information on whether CPT code 19396 is reimbursable in your specific jurisdiction.
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