CPT code 42815 is a medical billing code used for the excision of a neck cyst, helping healthcare providers accurately document and bill for the procedure.
CPT code 42815 is for the excision of a neck cyst. This procedure involves the surgical removal of a cyst located in the neck area, which may be causing discomfort or other complications. The excision is typically performed to alleviate symptoms, prevent infection, or for diagnostic purposes.
For CPT code 42815 (Excision of neck cyst), 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. 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: Used if the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
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 started but 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. This modifier is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
7. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial procedure.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: Used when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required because a qualified resident surgeon is not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when a physician assistant, nurse practitioner, or clinical nurse specialist provides services as an assistant at surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
When determining if CPT code 42815 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by your regional Medicare Administrative Contractor (MAC). The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various services, and it is updated annually. Each MAC, which administers Medicare claims for specific regions, may have additional local coverage determinations (LCDs) that can affect reimbursement.
To verify if CPT code 42815 is reimbursed, you should:
1. Check the MPFS: Access the latest version of the Medicare Physician Fee Schedule to see if CPT code 42815 is listed and what the reimbursement rate is.
2. Consult Your MAC: Review any LCDs or other guidance documents provided by your regional MAC to ensure there are no specific restrictions or additional requirements for reimbursement.
By following these steps, you can determine if CPT code 42815 is reimbursed by Medicare and understand any conditions that may apply.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 42815. Schedule a demo today to see how RevFind can help you identify and address underpayments by individual payer, ensuring you receive the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
