CPT code 42870 is a medical billing code used for the excision of the lingual tonsil, helping healthcare providers accurately document procedures.
CPT code 42870 is for the surgical procedure involving the excision of the lingual tonsil, which is the removal of the tonsil tissue located at the base of the tongue. This procedure is typically performed to address issues such as chronic inflammation, infection, or obstructive sleep apnea related to enlarged lingual tonsils.
For CPT code 42870 (Excision of lingual tonsil), 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 increased complexity or difficulty of the procedure.
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 helps in identifying that more than one procedure was carried out.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. 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.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
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: Used when a related procedure is performed during the postoperative period of the initial procedure.
9. 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.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
13. 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 in providing additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 42870, which involves the excision of the lingual tonsil, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B.
Additionally, it's important to consult with your local Medicare Administrative Contractor (MAC) for any specific guidelines or variations in reimbursement policies that may apply to your region. The MAC is responsible for processing Medicare claims and can provide detailed information on coverage and payment for CPT code 42870.
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