CPT code 42507 is a medical billing code used to describe the procedure of parotid duct diversion in healthcare settings.
CPT code 42507 is a procedure that involves the diversion of the parotid duct, which is the duct that carries saliva from the parotid gland to the mouth. This procedure is typically performed to manage conditions that affect salivary flow or to alleviate symptoms related to salivary gland disorders. By redirecting the duct, healthcare providers aim to improve patient comfort and function related to saliva production and secretion.
For CPT code 42507 (Parotid duct diversion), 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. Documentation must support the substantial additional work and the reason for it.
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 is 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. Documentation should support the reason for the reduction.
5. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the procedure is distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if the same procedure is repeated by a different physician on the same day.
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
- This modifier is used when a related procedure is performed during the postoperative period of the initial procedure.
9. 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.
10. Modifier LT - Left Side
- Apply this modifier to indicate that the procedure was performed on the left side of the body.
11. Modifier RT - Right Side
- Use this modifier to indicate that the procedure was performed on the right side of the body.
12. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon is required for the procedure.
14. 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.
15. 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.
Each modifier serves a specific purpose and should be used in accordance with the guidelines to ensure accurate billing and reimbursement. Proper documentation is crucial to support the use of any modifier.
The CPT code 42507, which pertains to parotid duct diversion, is reimbursed by Medicare. To determine the reimbursement specifics, 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 relevant Medicare Administrative Contractor (MAC) for your region, as they are responsible for processing Medicare claims and can provide detailed information on coverage policies and any potential local variations in reimbursement.
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 42507. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and ensure you receive the full reimbursement you deserve.
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