CPT code 42842 is a code used to describe extensive surgery of the throat for billing and documentation purposes in healthcare.
CPT code 42842 is used to describe an extensive surgical procedure performed on the throat. This code indicates that the surgery involves significant intervention, which may include the removal of tissue or structures in the throat, addressing complex conditions, or performing reconstructive work. It is typically utilized in cases where a more comprehensive approach is necessary to treat severe throat issues, such as tumors or other significant abnormalities.
For CPT code 42842, which pertains to extensive surgery of the throat, 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 complications or other factors that increase the complexity of the surgery.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the extensive throat surgery was one of several procedures performed.
3. Modifier 59 - Distinct Procedural Service: Used to identify procedures/services that are not normally reported together but are appropriate under the circumstances. This could be relevant if the extensive throat surgery is distinct from other services provided on the same day.
4. Modifier 62 - Two Surgeons: Indicates that two surgeons worked together as primary surgeons performing distinct parts of the procedure. This is applicable if the extensive nature of the surgery required the expertise of two surgeons.
5. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required to help with the procedure. This modifier is relevant if the complexity of the surgery necessitates an assistant.
6. Modifier 81 - Minimum Assistant Surgeon: Applied when an assistant surgeon is required for a short duration during the procedure. This could be relevant if the assistant's involvement was minimal but necessary.
7. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when a qualified resident surgeon is not available, and an assistant surgeon is required. This is applicable in teaching hospitals where residents are typically available.
8. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Indicates that a non-physician practitioner assisted in the surgery. This is relevant if a PA, NP, or CNS was involved in the procedure.
Each of these modifiers serves to provide additional information about the circumstances under which the extensive throat surgery was performed, ensuring accurate billing and appropriate reimbursement.
CPT code 42842 is reimbursed by Medicare. The reimbursement rate for this code is determined by the Medicare Physician Fee Schedule (MPFS). Healthcare providers should consult their local Medicare Administrative Contractor (MAC) for specific coverage guidelines and payment rates, as these may vary by region.
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