CPT code 47381 is a medical billing code for the procedure of open ablation of a liver tumor using cryotherapy.
CPT code 47381 is used to describe the procedure of open ablation of a liver tumor using cryotherapy. This involves surgically accessing the liver and applying extreme cold to destroy cancerous tissue within the tumor. The goal of this procedure is to reduce or eliminate the tumor while minimizing damage to surrounding healthy liver tissue.
For CPT code 47381, which pertains to the open ablation of a liver tumor using cryoablation, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
3. Modifier 59 (Distinct Procedural Service): Used to indicate that the procedure is distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 (Two Surgeons): Applied when two surgeons work together as primary surgeons performing distinct parts of the procedure. Each surgeon should report their distinct operative work.
5. Modifier 66 (Surgical Team): Used when a highly complex procedure requires the services of several physicians, often of different specialties, working together as a team.
6. Modifier 76 (Repeat Procedure by Same Physician): Used when the same physician repeats the procedure on the same day.
7. Modifier 77 (Repeat Procedure by Another Physician): Applied when a procedure is repeated by another physician on the same day.
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 the patient requires a return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Applied when a procedure is performed by the same physician during the postoperative period of another procedure, but the procedure is unrelated to the original.
10. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required during the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): Applied when an assistant surgeon is required for a minimal portion of 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): Applied when a non-physician practitioner assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining if CPT code 47381 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various services, and it is updated annually.
To verify if CPT code 47381 is reimbursed, you would need to check the MPFS for the current year. Additionally, MACs, which are private health care insurers that have been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims, may have specific guidelines or local coverage determinations (LCDs) that affect reimbursement.
Therefore, to confirm if CPT code 47381 is reimbursed by Medicare, you should:
1. Review the current MPFS to see if the code is listed and what the reimbursement rate is.
2. Check with your regional MAC for any specific coverage policies or LCDs that might apply to CPT code 47381.
By following these steps, you can determine the reimbursement status of CPT code 47381 under Medicare.
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