CPT code 42961 is used to describe the procedure for controlling throat bleeding in healthcare settings.
CPT code 42961 is used to describe the procedure for controlling bleeding in the throat. This code specifically refers to interventions performed to manage hemorrhage in the oropharyngeal area, which may involve techniques such as cauterization or ligation to stop the bleeding effectively.
For CPT code 42961 (Control throat bleeding), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more effort or time than typically required.
2. Modifier 51 - Multiple Procedures
- Apply this modifier if multiple procedures were performed during the same session.
3. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 59 - Distinct Procedural Service
- Apply this modifier if the procedure was distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure was repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if the same procedure was repeated by a different physician on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Use this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if an unrelated procedure was performed by the same physician during the postoperative period.
9. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was necessary for the procedure.
10. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
Each modifier serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 42961 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, it is advisable to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific guidelines that may apply to the reimbursement of CPT code 42961. The MACs are responsible for processing Medicare claims and can provide detailed information on coverage and payment policies.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 42961. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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