CPT code 48100 is for an open biopsy of the pancreas, a procedure to remove tissue for examination.
CPT code 48100 is for an open biopsy of the pancreas. This procedure involves surgically removing a small sample of pancreatic tissue for examination. It is typically performed to diagnose conditions such as pancreatitis, pancreatic cancer, or other pancreatic disorders. The open approach indicates that the surgeon makes a larger incision to access the pancreas directly, allowing for a more comprehensive evaluation of the tissue.
For CPT code 48100 (Biopsy of pancreas, open), 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.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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.
7. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
8. Modifier 66 - Surgical Team: Used when a highly complex procedure is carried out by a surgical team.
9. Modifier 76 - Repeat Procedure or Service by Same Physician: Used when the same physician repeats a procedure or service.
10. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician.
11. 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 patient returns to the operating room for a related procedure during the postoperative period.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
15. 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.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these non-physician practitioners assist in surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 48100, which pertains to a specific medical procedure, is subject to reimbursement by Medicare. To determine if this code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B. Additionally, it is essential to consult the local Medicare Administrative Contractor (MAC) for specific coverage policies and any potential regional variations in reimbursement. The MAC is responsible for processing Medicare claims and can provide guidance on whether CPT code 48100 is reimbursed in your specific jurisdiction.
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