CPT code 42410 is for the surgical excision of the parotid gland or a lesion within it, used for billing and documentation in healthcare.
CPT code 42410 is used to describe the surgical procedure of excising (removing) the parotid gland or a lesion located within the parotid gland. This procedure is typically performed to address conditions such as tumors or other abnormalities affecting the gland, which is one of the major salivary glands located near the jaw. The excision may involve the complete removal of the gland or just the specific lesion, depending on the clinical situation.
For CPT code 42410 (Excise parotid gland/lesion), 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 physical and mental effort.
2. Modifier 50 - Bilateral Procedure: Apply this modifier if the procedure was performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures: Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that the procedure was one of several performed.
4. Modifier 52 - Reduced Services: This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Apply this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
7. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
8. Modifier 66 - Surgical Team: Apply this modifier when a team of surgeons is required to perform the procedure due to its complexity.
9. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same physician needs to repeat the procedure on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a different physician repeats the procedure on the same day.
11. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Apply this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
13. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help with the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Apply this modifier when an assistant surgeon provides minimal assistance during the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when 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.
The CPT code 42410, which involves the excision of the parotid gland or lesion, 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 administer Medicare claims and can provide detailed information on coverage and reimbursement policies for CPT code 42410.
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