CPT code 42420 is used for the surgical removal of the parotid gland or a lesion from it, helping to standardize medical billing and documentation.
CPT code 42420 is used to describe the surgical procedure of excising (removing) a lesion from the parotid gland. This code specifically indicates that the procedure involves the removal of abnormal tissue or growths located in the parotid gland, which is one of the major salivary glands situated near the jaw. The excision may be performed for diagnostic purposes or to treat conditions such as tumors or infections affecting the gland.
For CPT code 42420 (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, severity of the patient's condition, or physical and mental effort required.
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 primary procedure was accompanied by additional procedures.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion. It indicates that the service provided was less than usually required.
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 a procedure or service was distinct or independent from other services performed on the same day. This is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
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 procedure is repeated by another physician 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 when 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 assist the primary surgeon during 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 required 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 physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement.
The CPT code 42420 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code. Additionally, MACs are responsible for processing Medicare claims and can offer region-specific guidance on coverage and reimbursement policies.
Therefore, while CPT code 42420 is generally reimbursed, checking with the MPFS and your MAC will ensure accurate and up-to-date information tailored to your practice's location.
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