CPT code 21602 is for the excision of a chest wall tumor without lymph node dissection.
CPT code 21602 is for the surgical procedure involving the excision (removal) of a chest wall tumor without the need for lymphadenectomy (removal of lymph nodes). This code is used to document and bill for the specific operation where the tumor is removed from the chest wall but does not include the additional step of removing lymph nodes.
For CPT code 21602 (Excision of chest wall tumor without lymphadenectomy), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could apply if the excision of the chest wall tumor is more complex than usual.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body. This would be relevant if tumors are excised from both sides of the chest wall.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This could apply if other procedures are performed in addition to the excision of the chest wall tumor.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion. This might be relevant if the excision is less extensive than initially planned.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This could apply if the excision of the chest wall tumor is performed in a different session or anatomical site from other procedures.
6. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure. This might be relevant if the excision requires the expertise of two surgeons.
7. Modifier 66 - Surgical Team: Used when a team of surgeons is required to perform the procedure. This could apply if the excision of the chest wall tumor is particularly complex and requires a multidisciplinary team.
8. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician. This might be relevant if the excision needs to be performed again due to recurrence or incomplete removal.
9. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician. This could apply if another surgeon needs to perform the excision due to recurrence or complications.
10. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used if the patient needs to return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
12. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required to help with the procedure. This might be relevant if the excision of the chest wall tumor is complex and requires additional surgical assistance.
13. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required. This could apply if the excision is less complex but still requires some assistance.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these healthcare professionals assist in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
When determining if a specific CPT code, such as 21602 (Excision of chest wall tumor without lymphadenectomy), is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and Local Coverage Determinations (LCDs) or National Coverage Determinations (NCDs).
For CPT code 21602, Medicare does provide reimbursement, but the amount can vary based on several factors, including geographic location, the setting in which the service is provided (e.g., hospital outpatient department vs. physician's office), and any applicable modifiers.
As of the latest available data, the national average reimbursement rate for CPT code 21602 is approximately $1,200. However, this figure is subject to change and should be verified through the MPFS or your Medicare Administrative Contractor (MAC) for the most accurate and up-to-date information.
To ensure accurate billing and reimbursement, healthcare providers should also verify any specific documentation requirements or coverage limitations that may apply to this procedure under Medicare guidelines.
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