CPT code 42310 is for the drainage of a salivary gland, a procedure to remove fluid buildup or infection from the gland.
CPT code 42310 is for the drainage of a salivary gland. This procedure involves the removal of fluid or pus from a salivary gland, typically to relieve swelling, infection, or blockage. It is often performed when a patient presents with symptoms such as pain or swelling in the area of the gland, and it may involve the use of a needle or incision to access the gland and facilitate drainage.
For CPT code 42310 (Drainage of salivary gland), 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.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same session.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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.
7. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a related procedure is performed during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in surgery.
Each modifier provides specific information about the circumstances under which the procedure was performed, ensuring accurate billing and appropriate reimbursement.
The CPT code 42310, which involves the drainage of a salivary gland, is reimbursed by Medicare. To determine the specific reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for various services covered by Medicare. Additionally, it is important to consult with your regional Medicare Administrative Contractor (MAC) for any local coverage determinations or specific billing guidelines that may affect reimbursement for CPT code 42310.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 42310. Schedule a demo today to see how RevFind can identify discrepancies by individual payer and help you maximize your revenue.
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