CPT code 31775 is used for procedures involving the reconstruction of the bronchus, a part of the respiratory system.
CPT code 31775 is used to describe the surgical procedure of reconstructing the bronchus. This code is typically utilized when a healthcare provider performs a surgical intervention to repair or reconstruct the bronchial tubes, which are the air passages that lead from the trachea to the lungs. Such a procedure may be necessary due to conditions like trauma, tumors, or congenital abnormalities affecting the bronchial structure. The reconstruction aims to restore normal airway function and improve respiratory health.
For CPT code 31775, "Reconstruct bronchus," 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 procedure required significantly greater effort or complexity than typically required. Documentation should support the increased complexity.
2. Modifier 51 (Multiple Procedures): Apply this modifier if multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed.
3. Modifier 52 (Reduced Services): This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion. Documentation should clearly explain the reduction in services.
4. Modifier 53 (Discontinued Procedure): Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
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. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 62 (Two Surgeons): Apply this modifier when two surgeons work together as primary surgeons performing distinct parts of a procedure.
7. Modifier 66 (Surgical Team): Use this modifier when a team of surgeons is required to perform the procedure due to its complexity.
8. 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.
9. Modifier 77 (Repeat Procedure by Another Physician): Use this modifier when the same procedure is repeated by a different physician on the same day.
10. 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 when a patient requires a return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Apply this modifier when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
12. Modifier 80 (Assistant Surgeon): Use this modifier when an assistant surgeon is required for the procedure.
13. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when a minimum assistant surgeon is required for the procedure.
14. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Apply this modifier when an assistant surgeon is required, and a qualified resident surgeon is not available.
15. Modifier 99 (Multiple Modifiers): Use this modifier when two or more modifiers are necessary to describe the service provided.
Each modifier should be used in accordance with payer policies and specific documentation requirements to ensure appropriate reimbursement and compliance.
CPT code 31775, which involves reconstructing the bronchus, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in determining whether a specific CPT code is reimbursable and at what rate. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals under Medicare Part B.
However, it's important to note that the final decision on reimbursement can also depend on the local policies set by the Medicare Administrative Contractor (MAC) in your region. MACs are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that can influence whether a particular service is covered. Therefore, while CPT code 31775 may be listed in the MPFS, healthcare providers should verify with their specific MAC to ensure compliance with any local coverage requirements or documentation guidelines that may affect reimbursement.
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