CPT code 31654 is used for a procedure involving a bronchial endobronchial ultrasound to investigate peripheral lesions.
CPT code 31654 is used to describe a medical procedure known as "Bronchoscopy with endobronchial ultrasound (EBUS) for the evaluation of peripheral lesions." This procedure involves using a bronchoscope, which is a flexible tube with a camera, to examine the airways and lungs. The addition of endobronchial ultrasound allows the physician to obtain real-time images of the structures surrounding the airways, particularly focusing on peripheral lung lesions. This technique is valuable for diagnosing and staging lung cancer, as well as for evaluating other pulmonary conditions. The use of EBUS enhances the ability to visualize and access areas that are difficult to reach with traditional bronchoscopy, providing a minimally invasive option for tissue sampling and diagnosis.
For CPT code 31654, which involves bronchoscopic procedures, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to increased complexity or difficulty of the procedure.
2. Modifier 26 - Professional Component: This is used when only the professional component of the service is being billed, such as the interpretation of the results.
3. Modifier 52 - Reduced Services: This modifier is applicable when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: This 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 or Service by Same Physician or Other Qualified Health Care Professional: Used when the same procedure is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is used when the procedure is repeated by a different provider.
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 is used when a 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: 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: This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used 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 is used when an assistant surgeon is necessary due to the unavailability of a qualified resident.
13. Modifier 99 - Multiple Modifiers: This is used when two or more modifiers are necessary to describe the service provided.
These modifiers help in accurately describing the circumstances under which the procedure was performed, ensuring proper billing and reimbursement. Always consult the latest CPT coding guidelines and payer-specific policies for the most accurate application of modifiers.
The CPT code 31654 is subject to reimbursement by Medicare, but its eligibility for payment 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) for the region in which the service is provided.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers on a fee-for-service basis. Each MAC, which administers Medicare benefits in different regions, may have specific coverage policies and local coverage determinations (LCDs) that affect whether and how a particular CPT code like 31654 is reimbursed.
Providers should verify the code's status in the MPFS and consult their regional MAC for any additional coverage criteria or documentation requirements to ensure proper reimbursement.
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