CPT code 42665 is a medical billing code used for the ligation of a salivary duct procedure in healthcare revenue cycle management.
CPT code 42665 is the procedure for ligation of the salivary duct. This surgical intervention involves tying off a salivary duct to reduce or eliminate saliva flow, often performed to address conditions such as salivary gland stones or chronic sialorrhea. The procedure aims to alleviate symptoms and improve the patient's quality of life by managing excessive saliva production or blockage.
For CPT code 42665 (Ligation of salivary duct), 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.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both sides of the body during the same 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.
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.
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
- This modifier is used when 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
- Apply this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. 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.
10. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon is required for the procedure.
12. 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.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a non-physician provider assists in the surgery.
Each modifier serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest CPT coding guidelines and payer-specific policies for the most accurate and up-to-date information.
The CPT code 42665, which pertains to the ligation of a salivary duct, 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 the local Medicare Administrative Contractor (MAC) for any region-specific guidelines or coverage determinations that may affect reimbursement. The MACs are responsible for processing Medicare claims and can provide detailed information on any local coverage determinations (LCDs) that might impact the reimbursement of CPT code 42665.
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