CPT code 48180 is a medical billing code used to describe the procedure of fusing the pancreas and bowel in healthcare settings.
CPT code 48180 is used to describe a surgical procedure that involves fusing the pancreas to the bowel. This procedure is typically performed to create a connection between the pancreas and the digestive tract, often in cases where there is a need to bypass or address issues related to pancreatic function or disease. The fusion helps facilitate the proper flow of digestive enzymes and aids in the management of certain pancreatic conditions.
For CPT code 48180, which pertains to the fusion of the pancreas and bowel, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required. This could be due to complications or other factors that increase the complexity of the surgery.
2. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. This indicates that more than one procedure was carried out, which can affect reimbursement.
3. Modifier 59 - Distinct Procedural Service
- This modifier is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances. It indicates that the procedure was distinct or independent from other services performed on the same day.
4. Modifier 62 - Two Surgeons
- Use this modifier when two surgeons work together as primary surgeons performing distinct parts of the procedure. Each surgeon should report their distinct operative work by appending this modifier.
5. Modifier 66 - Surgical Team
- This modifier is applicable when a complex procedure requires the services of several physicians, often of different specialties, working together as a team.
6. 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 needs to return to the operating room for a related procedure during the postoperative period of the initial surgery.
7. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required to help with the procedure. It indicates that another surgeon assisted the primary surgeon during the operation.
8. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier when an assistant surgeon is required for a portion of the procedure but not for the entire operation.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used when a qualified resident surgeon is not available, and an assistant surgeon is necessary for the procedure.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement for the services provided.
CPT code 48180 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, coverage and payment may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. It's essential to verify with your local MAC for any specific coverage guidelines or documentation requirements associated with this code.
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