CPT code 48150 is for the partial removal of the pancreas, a surgical procedure to treat various pancreatic conditions.
CPT code 48150 is for the partial removal of the pancreas, a surgical procedure that involves excising a portion of the pancreatic tissue. This procedure may be performed to treat conditions such as pancreatic tumors, chronic pancreatitis, or other pancreatic diseases. The code specifically indicates that only a part of the pancreas is removed, rather than the entire organ.
For CPT code 48150, which pertains to the partial removal of the pancreas, 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 helps in indicating that more than one procedure was carried out.
3. Modifier 52 - Reduced Services
- Utilized when the procedure is partially reduced or eliminated at the physician's discretion. This modifier indicates that the service provided was less than usually required.
4. Modifier 53 - Discontinued Procedure
- Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service
- Applied to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to avoid bundling issues.
6. Modifier 62 - Two Surgeons
- Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
7. Modifier 66 - Surgical Team
- Applied when a highly complex procedure requires the services of several physicians, often of different specialties, working together as a team.
8. Modifier 76 - Repeat Procedure by Same Physician
- Used when the same physician performs a procedure or service more than once on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician
- Applied when a procedure or service is repeated by another physician 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
- Used when a patient requires a 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
- Applied when a procedure or service performed during the postoperative period is unrelated to the original procedure.
12. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required to help with the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Applied when a minimum assistant surgeon is required for the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Applied when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 48150 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, including the associated payment rates.
Additionally, reimbursement can vary based on the region and the specific Medicare Administrative Contractor (MAC) overseeing the claims in that area. Each MAC may have unique guidelines and policies that impact the reimbursement process for CPT code 48150.
Therefore, healthcare providers should consult the MPFS and their respective MAC for precise and up-to-date information regarding the reimbursement of this code.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level and by individual payer. Imagine identifying discrepancies for specific procedures like CPT code 48150. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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