CPT code 48120 is for the surgical removal of a lesion from the pancreas, helping healthcare providers accurately bill for this procedure.
CPT code 48120 is used to describe the surgical procedure for the removal of a lesion from the pancreas. This code specifically indicates that the procedure involves excising a tumor or abnormal growth located in the pancreatic tissue, which may be necessary for diagnostic or therapeutic purposes.
When billing for the procedure associated with CPT code 48120, various modifiers may be required to provide additional information about the service performed. Below is a list of potential modifiers that could be used, along with the reasons for their application:
1. Modifier 22 - Increased Procedural Services
- Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 51 - Multiple Procedures
- Applied when multiple procedures are performed during the same surgical session.
3. Modifier 52 - Reduced Services
- Used when the procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure
- Applied when the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
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 62 - Two Surgeons
- Applied when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
7. Modifier 66 - Surgical Team
- Used when a highly complex procedure is carried out by a surgical team.
8. Modifier 76 - Repeat Procedure by Same Physician
- Applied when the same procedure is repeated by the same physician subsequent to the original procedure.
9. Modifier 77 - Repeat Procedure by Another Physician
- Used when the same procedure is repeated by another physician subsequent to the original procedure.
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
- Applied when a related procedure is performed during the postoperative period of the initial procedure.
11. 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.
12. Modifier 80 - Assistant Surgeon
- Applied when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Used when a minimum assistant surgeon is required during the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Applied when an assistant surgeon is required and a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
These modifiers help provide a more accurate description of the circumstances surrounding the procedure and ensure appropriate reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
When determining if CPT code 48120 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by your regional Medicare Administrative Contractor (MAC). The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various services, and it is updated annually.
For CPT code 48120, you would first check the MPFS to see if the code is listed and if it has an assigned reimbursement rate. If the code is present in the MPFS, it indicates that Medicare does reimburse for this service, subject to the specific conditions and guidelines outlined by your MAC. Each MAC may have additional local coverage determinations (LCDs) that could affect reimbursement, so it is crucial to review these as well.
In summary, to confirm if CPT code 48120 is reimbursed by Medicare, you need to verify its inclusion and reimbursement rate in the MPFS and consult any relevant LCDs from your MAC.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 48120. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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