CPT code 42835 is for the surgical removal of adenoids, a common procedure to treat breathing issues and infections in patients.
CPT code 42835 is for the surgical procedure involving 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 42835, which pertains to the 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: Used 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: Used if the same procedure is repeated by the same physician.
5. Modifier 77 - Repeat Procedure by Another Physician: Used if the same 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: Used if the patient needs to 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 if an unrelated procedure is performed by the same physician during the postoperative period.
8. Modifier 80 - Assistant Surgeon: Used if an assistant surgeon is required during the procedure.
9. Modifier 81 - Minimum Assistant Surgeon: Used if a minimum assistant surgeon is required.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used if 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 if these healthcare professionals assist in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 42835 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any applicable guidelines, healthcare providers should consult the MPFS.
Additionally, it is important to verify with the respective Medicare Administrative Contractor (MAC) for any regional variations or additional requirements that may apply to the reimbursement of CPT code 42835.
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