CPT code 42831 is used to identify the procedure for the surgical removal of adenoids in healthcare billing and documentation.
CPT code 42831 is used to describe the surgical procedure for the removal of adenoids, which are small masses of lymphatic tissue located at the back of the nasal cavity. This procedure is typically performed to alleviate breathing difficulties, recurrent infections, or other complications associated with enlarged adenoids.
For CPT code 42831 (Removal of adenoids), the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session.
3. 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.
4. Modifier 76 - Repeat Procedure by Same Physician: Applied if the same procedure is repeated by the same physician.
5. Modifier 77 - Repeat Procedure by Another Physician: Used if the procedure is repeated by a different physician.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Indicates an unplanned return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
8. Modifier 80 - Assistant Surgeon: Applied when an assistant surgeon is required for the procedure.
9. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Applied when an assistant surgeon is required, and a qualified resident surgeon is not available.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist 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 42831 is reimbursed by Medicare. This code is included in the Medicare Physician Fee Schedule (MPFS) and is eligible for payment. Healthcare providers should consult their local Medicare Administrative Contractor (MAC) for specific coverage guidelines and reimbursement rates, as these may vary by region.
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