CPT code 42415 is used for the excision of a parotid gland or lesion, detailing the specific procedure for billing and documentation purposes.
CPT code 42415 is used to describe the surgical procedure of excising (removing) a lesion from the parotid gland, which is one of the major salivary glands located near the jaw. This code indicates that the procedure involves the complete removal of the lesion, which may be necessary for diagnostic purposes or to treat conditions such as tumors or infections affecting the parotid gland.
For CPT code 42415, which pertains to the excision of the parotid gland or lesion, 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.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
8. Modifier 66 - Surgical Team: Used when a highly complex procedure is carried out by a surgical team.
9. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
10. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by another physician.
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: Used when a related procedure is performed during the postoperative period.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary and a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these professionals assist in surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 42415, which involves the excision of the parotid gland or lesion, is reimbursed by Medicare. To determine the specific reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for various CPT codes, including 42415. Additionally, reimbursement can vary slightly depending on the region, as Medicare Administrative Contractors (MACs) may have localized adjustments. Therefore, it is advisable to consult the relevant MAC for precise reimbursement details in your specific area.
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