CPT code 31653 is used for a procedure involving bronchial endobronchial ultrasound sampling of three or more lymph node stations.
CPT code 31653 is used to describe a medical procedure known as "bronchoscopy with endobronchial ultrasound (EBUS) for sampling three or more mediastinal and/or hilar lymph node stations or structures." This procedure involves using a bronchoscope, which is a thin, flexible tube equipped with a camera and ultrasound capabilities, to examine the airways and surrounding structures within the chest. The endobronchial ultrasound allows the physician to visualize and access lymph nodes or masses located near the airways. During this procedure, samples are taken from three or more lymph node stations or structures for diagnostic purposes, such as evaluating for cancer or infection. This code is specifically used to document and bill for the complexity and extent of the sampling performed during the procedure.
For CPT code 31653, which involves bronchoscopic procedures with endobronchial ultrasound (EBUS) for sampling three or more 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, and not the technical component.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the procedure is performed, 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 considered part of another service.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the same physician repeats the procedure on the same day for the same patient.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a different physician repeats the procedure on the same day for the same patient.
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 returns 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 the procedure is unrelated to the original procedure and is performed during the postoperative period.
8. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide a service is substantially greater than typically required.
9. Modifier 52 - Reduced Services: This modifier is applicable if the procedure was partially reduced or eliminated at the physician's discretion.
10. Modifier 53 - Discontinued Procedure: This modifier is used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines, as modifier usage can vary.
The CPT code 31653 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that outlines the payment rates for services covered under Medicare Part B, including those associated with CPT codes. To determine if CPT code 31653 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the associated reimbursement rates.
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 make local coverage determinations (LCDs) that can affect whether a specific CPT code, such as 31653, is reimbursed in their jurisdiction. Providers should check with their respective MAC to ensure that CPT code 31653 is covered and to understand any specific documentation or billing requirements that may apply.
In summary, while CPT code 31653 can be reimbursed by Medicare, providers must verify its inclusion in the MPFS and consult their MAC for any local coverage policies that might impact reimbursement.
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