CPT code 42330 is for the removal of a salivary stone, a procedure to alleviate blockages in the salivary glands.
CPT code 42330 is the procedure for the removal of a salivary stone. This code is used when a healthcare provider performs a surgical intervention to extract a stone that has formed in the salivary glands, which can cause pain, swelling, and infection. The procedure typically involves accessing the gland through the mouth or skin to eliminate the obstruction and restore normal salivary function.
For CPT code 42330 (Removal of salivary stone), 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 factors such as the size or location of the salivary stone.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This modifier indicates that the removal of the salivary stone is one of several procedures performed.
4. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the physician's discretion. This might apply if the removal of the salivary stone was less extensive than usual.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that the procedure is distinct or independent from other services performed on the same day. This might be necessary if the removal of the salivary stone is performed in conjunction with other procedures that are not typically performed together.
6. Modifier 76 - Repeat Procedure by Same Physician: Used if the same procedure needs to be repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Used if the same procedure needs to be repeated by a different physician on the same day.
8. 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 if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used if the removal of the salivary stone is performed during the postoperative period of another, unrelated procedure.
10. Modifier 80 - Assistant Surgeon: Used if an assistant surgeon is required to help with the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used if an assistant surgeon is required for a minimal portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used if an assistant surgeon is required because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used if a non-physician practitioner assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 42330 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. It's important to verify with your local MAC for any specific coverage guidelines or documentation requirements associated with this code.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 42330, RevFind provides unparalleled accuracy by individual payer. Schedule a demo today to see how RevFind can optimize your revenue cycle and protect your bottom line.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
