CPT code 48105 is for the surgical procedure to resect or debride the pancreas, often used in treating pancreatic conditions.
CPT code 48105 is used to describe the surgical procedure of resecting or debriding the pancreas. This involves the removal of a portion of the pancreatic tissue or the cleaning of infected or necrotic tissue from the pancreas, typically performed to treat conditions such as pancreatic cancer or severe pancreatitis.
When using CPT code 48105 for resecting or debriding the pancreas, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort or complexity than typically required.
2. Modifier 51 - Multiple Procedures
- Apply this modifier if multiple procedures were performed during the same surgical session.
3. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure
- Apply this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threatened the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 62 - Two Surgeons
- Apply this modifier if two surgeons worked together as primary surgeons performing distinct parts of the procedure.
7. Modifier 66 - Surgical Team
- Use this modifier if the procedure required the services of a surgical team.
8. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same physician performed the procedure more than once on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician performed the procedure more than once on the same day.
10. 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.
11. 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.
12. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required for the procedure.
14. 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.
15. 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 of these modifiers provides additional information that can affect billing and reimbursement, ensuring that the specifics of the procedure are accurately communicated to payers.
The CPT code 48105, which involves resecting or debriding the pancreas, is subject to reimbursement by Medicare. To determine if this specific CPT 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, reimbursement can vary based on the local policies of the Medicare Administrative Contractor (MAC) responsible for the specific geographic region. Each MAC may have unique guidelines and coverage determinations that impact whether CPT code 48105 is reimbursed. Therefore, it is essential to consult both the MPFS and the relevant MAC for the most accurate and up-to-date information.
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