CPT code 31717 is used for a bronchial brush biopsy, a procedure to collect cells from the airways for examination.
CPT code 31717 is used to describe a bronchial brush biopsy procedure. This code is specifically assigned to the process where a healthcare provider uses a small brush to collect cells from the bronchial tubes, which are the air passages that lead from the trachea to the lungs. This procedure is typically performed during a bronchoscopy, where a flexible tube with a camera is inserted into the airways to allow the physician to view the bronchial tubes and collect tissue samples. The collected cells are then examined under a microscope to help diagnose conditions such as infections, inflammation, or cancer.
For CPT code 31717, which pertains to a bronchial brush biopsy, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if 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 26 - Professional Component: This modifier is used when only the professional component of the service is being billed, such as the interpretation of the biopsy results.
3. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier when the procedure is repeated by a different physician on the same day.
7. 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.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Apply this modifier when the procedure is unrelated to the original procedure performed during the postoperative period.
9. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Use this modifier when a laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
10. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided.
Each modifier should be used in accordance with the specific guidelines and documentation requirements to ensure accurate billing and reimbursement.
CPT code 31717, which is associated with a bronchial brush biopsy, is subject to reimbursement by Medicare, but this depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines the reimbursement rates for services covered under Medicare Part B. To ascertain if CPT code 31717 is reimbursed, healthcare providers should consult the MPFS for the specific year in question, as reimbursement rates and coverage can vary annually.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in determining local coverage decisions and reimbursement policies. Each MAC may have specific guidelines or requirements for the reimbursement of CPT code 31717, which can include documentation requirements, medical necessity criteria, and other local coverage determinations (LCDs). Therefore, it is essential for healthcare providers to verify with their respective MAC to ensure compliance with any regional policies that may affect the reimbursement of this code.
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