CPT code 42335 is for the removal of a salivary stone, a procedure to alleviate blockages in the salivary glands.
CPT code 42335 is for the removal of a salivary stone. This procedure involves the surgical extraction of a stone that has formed in the salivary glands, which can cause pain, swelling, and infection. The code is used to document and bill for the specific surgical intervention performed to alleviate these symptoms and restore normal salivary function.
For CPT code 42335 (Removal of salivary stone), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly greater effort than typically required. Documentation must support the substantial additional work.
2. Modifier 50 - Bilateral Procedure: If the removal of salivary stones is performed on both sides during the same session, this modifier should be appended.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier should be used to indicate that multiple services were provided.
4. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used.
5. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the removal of the salivary stone was a distinct procedure from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: If the procedure needs to be repeated by the same physician, this modifier should be appended.
7. Modifier 77 - Repeat Procedure by Another Physician: If the procedure needs to be repeated by a different physician, this modifier should be used.
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: This modifier is 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: If an unrelated procedure is performed by the same physician during the postoperative period, this modifier should be used.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be appended.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: This modifier is used when these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Proper documentation is essential to support the use of any modifier.
The CPT code 42335, which pertains to the removal of a salivary stone, 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 are responsible for processing Medicare claims and can provide detailed information on coverage and reimbursement policies for CPT code 42335.
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