CPT code 31645 is used for a bronchoscopy procedure involving therapeutic aspiration, typically performed as the first intervention.
CPT code 31645 is used to describe a bronchoscopy procedure with therapeutic aspiration. This code is specifically for the initial instance of the procedure. Bronchoscopy is a diagnostic and therapeutic procedure that allows healthcare providers to examine the inside of the lungs, including the bronchi, which are the main pathways into the lungs. Therapeutic aspiration involves the removal of fluid, mucus, or other substances from the airways to improve breathing or to obtain samples for further analysis. This procedure is typically performed using a bronchoscope, a flexible tube with a camera and tools attached, which is inserted through the nose or mouth into the lungs.
For CPT code 31645, which involves bronchoscopy with therapeutic aspiration, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more effort or time than typically required. Documentation must support the increased complexity.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed bilaterally, this modifier indicates that the service was provided on both sides of the body.
3. Modifier 51 - Multiple Procedures: Apply this modifier when multiple procedures are performed during the same session. It indicates that more than one procedure was performed.
4. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
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.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician on the same day, this modifier should be used.
7. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the procedure is repeated by a different physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is applicable if the patient returns 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 for a procedure that is unrelated to the original procedure during the postoperative period.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be used.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier when an assistant surgeon is required for a minimal portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is 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 applicable.
Each modifier should be used in accordance with the specific circumstances of the procedure and must be supported by appropriate documentation to ensure accurate billing and reimbursement.
The CPT code 31645 is subject to reimbursement by Medicare, but its reimbursement is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that outlines the payment rates for services covered by Medicare, including those associated with CPT codes. To determine if CPT code 31645 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the specific payment rate applicable.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that may affect whether a particular service is reimbursed. Therefore, it is essential for healthcare providers to check with their respective MAC to ensure that CPT code 31645 is covered under their jurisdiction and to understand any specific documentation or billing requirements that may apply.
In summary, while CPT code 31645 can be reimbursed by Medicare, providers must verify its inclusion in the MPFS and consult their MAC for any additional coverage criteria or requirements.
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