CPT code 31652 is used for a procedure involving bronchial endobronchial ultrasound sampling of one or two lymph nodes or structures.
CPT code 31652 is used to describe a medical procedure known as "bronchoscopy with endobronchial ultrasound (EBUS) for sampling one or two mediastinal and/or hilar lymph node stations or structures." This procedure involves using a bronchoscope, which is a flexible tube with a camera and ultrasound probe, to visualize the airways and surrounding structures within the chest. The EBUS technology allows for real-time imaging of the lymph nodes and other structures, enabling the physician to obtain tissue samples for diagnostic purposes, such as evaluating for cancer or infection. This code specifically indicates that the sampling was performed on one or two lymph node stations or structures during the procedure.
For CPT code 31652, which involves bronchoscopic procedures with endobronchial ultrasound (EBUS) for sampling one or two mediastinal and/or hilar lymph node stations or structures, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the physician performs only the professional component of the procedure, such as the interpretation of the results, without providing the technical component.
2. Modifier TC - Technical Component: This is used when only the technical component of the procedure is provided, such as the use of equipment and supplies, without the professional interpretation.
3. Modifier 59 - Distinct Procedural Service: This modifier may be used if the procedure is distinct or independent from other services performed on the same day. It indicates that the procedure is not typically reported together but is appropriate under the circumstances.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same provider on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is applicable when the procedure is repeated by a different provider on the same day.
6. 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 if the patient needs to return to the operating room for a related procedure during the postoperative period.
7. 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 it is unrelated to the original procedure.
8. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician provider assists in the surgery.
These modifiers help clarify the specific circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 31652 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their respective reimbursement rates.
However, the actual reimbursement for CPT code 31652 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national policies and establish local coverage determinations, which can influence whether and how a particular service is reimbursed.
Therefore, healthcare providers should consult their specific MAC for detailed information on the reimbursement criteria and rates for CPT code 31652.
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