CPT code 42340 is for the removal of a salivary stone, a procedure to alleviate blockages in the salivary glands.
CPT code 42340 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 42340 (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. This could be due to factors such as increased complexity or time.
2. Modifier 50 - Bilateral Procedure: If the removal of salivary stones was performed on both sides during the same session, this modifier should be used.
3. Modifier 51 - Multiple Procedures: If multiple procedures were performed during the same surgical session, this modifier should be applied to indicate that more than one procedure was carried out.
4. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure was repeated by the same physician, this modifier should be used.
7. Modifier 77 - Repeat Procedure by Another Physician: If the procedure was repeated by a different physician, this modifier should be applied.
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: Use this modifier if the patient had 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: This modifier is used if an unrelated procedure was performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon was required during the procedure, this modifier should be used.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was 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: Use this modifier if a PA, NP, or CNS provided assistance during the surgery.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement.
CPT code 42340 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 how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 42340. Schedule a demo today to see how RevFind can help you identify and recover lost revenue from individual payers.
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
