CPT code 19499 is used for unlisted procedures related to the breast, covering services not specified by other codes.
CPT code 19499 is used to represent an unlisted procedure related to the breast. This code is utilized when a specific procedure performed on the breast does not have a designated CPT code. It allows healthcare providers to document and bill for unique or uncommon breast procedures that fall outside the standard coding system.
For CPT code 19499 (Unlisted procedure, 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 52 - Reduced Services
- Apply this modifier when a service or procedure is partially reduced or eliminated at the physician's discretion. Documentation should clearly indicate the reason for the reduction.
3. Modifier 53 - Discontinued Procedure
- This modifier is used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient. Proper documentation is necessary to explain the reason for discontinuation.
4. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Apply this modifier when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Use this modifier when a procedure or service is repeated by another physician or qualified healthcare professional subsequent to the original procedure or service.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
- This modifier is used when a related procedure is performed during the postoperative period of the initial procedure.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
- Apply this modifier when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 99 - Multiple Modifiers
- Use this modifier when two or more modifiers are necessary to describe the service provided. Documentation should clearly indicate the use of multiple modifiers.
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 documentation is crucial to justify the use of any modifier.
Determining whether CPT code 19499 (Unlisted procedure, breast) is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the Medicare Administrative Contractor (MAC) for your specific region.
CPT code 19499 is categorized as an unlisted procedure, which means it does not have a specific fee associated with it in the MPFS. Reimbursement for unlisted codes like 19499 typically requires additional documentation to justify the medical necessity and the complexity of the procedure performed.
The MAC for your region will review the submitted documentation and determine the appropriate reimbursement based on comparable procedures and the specifics of the case. Therefore, while CPT code 19499 can be reimbursed by Medicare, it is subject to a more detailed review process and is not guaranteed a standard reimbursement rate. Always ensure that comprehensive documentation accompanies the claim to facilitate the review and reimbursement process.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can read your contracts and detect underpayments down to the CPT code level, including specific codes like 19499. Don't leave money on the table—schedule a demo today to see how RevFind can help you identify and recover underpayments from individual payers.
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
