CPT code 48153 is for a pancreatectomy, a surgical procedure to remove part or all of the pancreas.
CPT code 48153 is for a pancreatectomy, which is a surgical procedure involving the removal of part or all of the pancreas. This procedure is typically performed to treat conditions such as pancreatic cancer, chronic pancreatitis, or other pancreatic disorders. The code specifically indicates that the surgery is a distal pancreatectomy, where the tail and body of the pancreas are removed, often along with the spleen.
For CPT code 48153 (Pancreatectomy), 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. This could be due to complications or other factors that increase the complexity of the procedure.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the pancreatectomy was one of several procedures performed.
3. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion. This could apply if the pancreatectomy was not completed as initially planned.
4. Modifier 53 - Discontinued Procedure: Applied 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: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This could be relevant if the pancreatectomy was performed in conjunction with other procedures that are not typically reported together.
6. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure. This could apply if the pancreatectomy required the expertise of two surgeons.
7. Modifier 66 - Surgical Team: Applied when a highly complex procedure is carried out by a surgical team. This could be relevant for a pancreatectomy that necessitates a multidisciplinary approach.
8. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure. This modifier indicates that another surgeon assisted in the pancreatectomy.
9. Modifier 81 - Minimum Assistant Surgeon: Applied when an assistant surgeon is required for a portion of the procedure. This could be relevant if the assistant was needed only for specific parts of the pancreatectomy.
10. 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. This could apply to the pancreatectomy if no resident was available to assist.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when a non-physician provider assists in the surgery. This could be relevant if a PA, NP, or CNS assisted in the pancreatectomy.
These modifiers help provide additional information about the circumstances under which the pancreatectomy was performed, ensuring accurate billing and reimbursement.
CPT code 48153 is reimbursed by Medicare. The code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, reimbursement may vary depending on factors such as geographic location and the specific Medicare Administrative Contractor (MAC) processing the claim. Providers should consult their local MAC for specific coverage and payment guidelines related to this procedure.
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