CPT code 41520 is for the surgical reconstruction of the tongue fold, used to describe a specific medical procedure in billing and documentation.
CPT code 41520 is for the surgical procedure known as reconstruction of the tongue fold. This procedure typically involves the repair or reconstruction of the tissue in the tongue area, often performed to address issues such as congenital defects, trauma, or other conditions that affect the structure and function of the tongue. The goal of this procedure is to restore normal anatomy and improve the patient's ability to speak and swallow.
For CPT code 41520 (Reconstruction tongue fold), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could be due to increased complexity or difficulty of the procedure.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
3. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This could be due to different anatomical sites or separate patient encounters.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure, each surgeon should report their distinct operative work by adding this modifier.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by the same provider subsequent to the original procedure.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Applied when a procedure or service is repeated by another provider subsequent to the original procedure.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a patient requires a return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: Indicates that a procedure performed during the postoperative period was unrelated to the original procedure.
9. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Applied when an assistant surgeon provides minimal assistance during the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Indicates that a non-physician provider assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 41520, which pertains to reconstruction tongue fold, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B.
Additionally, it is essential to consult with the specific Medicare Administrative Contractor (MAC) for your region, as they administer Medicare claims and can provide detailed information on coverage policies and any potential local coverage determinations (LCDs) that may affect reimbursement for CPT code 41520.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 41520. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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