CPT code 31640 is a medical code used to describe a bronchoscopy procedure where a tumor is removed from the airway.
CPT code 31640 is used to describe a medical procedure known as a bronchoscopy with tumor excision. This procedure involves using a bronchoscope, which is a thin, flexible tube equipped with a camera and light, to examine the airways and lungs. During this procedure, a healthcare provider can identify and remove a tumor from the bronchial tubes or lungs. The excision of the tumor is performed through the bronchoscope, allowing for a minimally invasive approach to treat or diagnose conditions related to abnormal growths in the respiratory tract. This code is crucial for accurate billing and documentation in the healthcare revenue cycle, ensuring that providers are reimbursed appropriately for the specialized care they deliver.
For CPT code 31640, which involves bronchoscopy with tumor excision, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: This modifier is used 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 50 - Bilateral Procedure: If the bronchoscopy with tumor excision is performed on both lungs during the same session, this modifier indicates that the procedure was performed bilaterally.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was performed.
4. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier indicates that the service provided was less than usually required.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 76 - Repeat Procedure or Service by Same Physician: If the same procedure is repeated by the same physician on the same day, this modifier is used to indicate the repeat service.
7. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician on the same day, this modifier is used.
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 used when a patient requires a 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: This modifier is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier indicates their involvement.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary due to the unavailability of a qualified resident.
13. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the service, this modifier indicates that multiple modifiers are being used.
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 essential to justify the use of any modifier.
The CPT code 31640 is subject to reimbursement by Medicare, but its reimbursement status depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) in your region.
The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates. However, the final determination of coverage and reimbursement for CPT code 31640 is made by the MAC, which may have additional local coverage determinations (LCDs) that affect whether and how the service is reimbursed.
It is crucial for healthcare providers to verify the specific reimbursement policies with their local MAC to ensure compliance and accurate billing.
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