CPT code 42845 is for extensive surgery of the throat, detailing specific procedures performed to treat throat conditions.
CPT code 42845 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 other complex procedures aimed at treating conditions affecting the throat. It is typically utilized in cases where less invasive treatments are insufficient, and a comprehensive surgical approach is necessary to address the patient's health issue.
For CPT code 42845, which pertains to extensive surgery of the throat, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
3. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures that are not normally reported together but are appropriate under the circumstances.
4. Modifier 62 (Two Surgeons): This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure. Each surgeon should report their distinct operative work.
5. Modifier 66 (Surgical Team): This modifier is used when a highly complex procedure is carried out by a surgical team. It indicates that the procedure required the skills of several surgeons.
6. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when a procedure or service performed by the same physician is repeated subsequent to the original procedure or service.
7. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a procedure or service performed by another physician is repeated subsequent to the original procedure or service.
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): This modifier is used when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when an unrelated procedure or service 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 during the procedure. It indicates that another surgeon assisted in the operation.
11. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when an assistant surgeon provides minimal assistance during the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used when an assistant surgeon is required 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 physician assistant, nurse practitioner, or clinical nurse specialist assists 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 42845 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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