CPT code 42405 is a medical billing code used for a biopsy of the salivary gland, helping to identify and document the procedure for insurance purposes.
CPT code 42405 is used to describe a biopsy procedure of the salivary gland. This code indicates that a sample of tissue has been taken from the salivary gland for diagnostic purposes, typically to evaluate for conditions such as tumors, infections, or other abnormalities. The procedure may involve the use of a needle or surgical techniques to obtain the tissue sample.
For CPT code 42405 (Biopsy of salivary gland), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as increased intensity, time, technical difficulty, or severity of the patient's condition.
2. Modifier 50 - Bilateral Procedure: If the biopsy is performed on both salivary glands during the same session, this modifier should be used to indicate a bilateral procedure.
3. Modifier 51 - Multiple Procedures: If the biopsy is performed in conjunction with other procedures, this modifier should be used to indicate multiple procedures performed during the same session.
4. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the biopsy was a distinct procedural service from other services performed on the same day. This is particularly relevant if the biopsy is performed in a different anatomical site or through a separate incision.
5. Modifier 76 - Repeat Procedure by Same Physician: If the biopsy needs to be repeated by the same physician on the same day, this modifier should be used.
6. Modifier 77 - Repeat Procedure by Another Physician: If the biopsy needs to be repeated by a different physician on the same day, this modifier should be used.
7. 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 needs to return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if the biopsy is performed during the postoperative period of another procedure but is unrelated to the initial procedure.
9. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the biopsy, this modifier should be used.
10. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required for the biopsy.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon is required because a qualified resident surgeon is not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assists in the biopsy.
13. Modifier LT - Left Side: Use this modifier if the biopsy is performed on the left salivary gland.
14. Modifier RT - Right Side: Use this modifier if the biopsy is performed on the right salivary gland.
These modifiers help provide additional information about the circumstances under which the biopsy was performed, ensuring accurate billing and reimbursement.
CPT code 42405 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 related to this procedure.
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