CPT code 40804 is used for billing the removal of a foreign body from the mouth in healthcare services.
CPT code 40804 is used to describe the procedure of removing a foreign body from the mouth. This code specifically applies when a healthcare provider performs an intervention to extract an object that has become lodged in the oral cavity, ensuring the patient's safety and comfort.
For CPT code 40804, "Removal foreign body mouth," the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the removal of the foreign body was significantly more complex or time-consuming than usual.
2. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
3. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the removal of the foreign body was a distinct procedural service performed separately from other services provided on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same physician needs to perform the removal procedure again on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician: Apply this modifier if a different physician performs the removal procedure again 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: Use this modifier 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 if the removal of the foreign body is unrelated to the original procedure performed during the postoperative period.
8. Modifier 80 - Assistant Surgeon: Apply this modifier if an assistant surgeon was necessary for the procedure.
9. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required for the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used if an assistant surgeon was required because a qualified resident surgeon was not available.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Apply this modifier if a PA, NP, or CNS provided assistant services during the procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 40804 is reimbursed by Medicare. The code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) and local coverage determinations. Providers should consult their regional MAC for specific coverage and payment guidelines related to this CPT code.
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