CPT code 42650 is a medical billing code used for the dilation of a salivary duct procedure in healthcare.
CPT code 42650 is the procedure for the dilation of a salivary duct. This involves the widening of a blocked or narrowed salivary duct to restore normal saliva flow. The procedure is typically performed to alleviate symptoms associated with duct obstruction, such as pain or swelling, and may involve the use of specialized instruments to achieve the dilation.
For CPT code 42650 (Dilation of salivary duct), the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 (Bilateral Procedure): This modifier is used if the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same session. It indicates that the procedure is one of several performed.
4. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
6. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
7. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
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): This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required during the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when a minimum assistant surgeon is required during the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used when an assistant surgeon is required and a qualified resident surgeon is not available.
13. 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.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 42650 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), indicating that it is a covered service. However, reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region and any applicable local coverage determinations. Providers should consult their local MAC for specific coverage and payment guidelines related to this procedure.
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