CPT code 48400 is an injection intraoperative add-on used to describe specific procedures during surgery for accurate billing and documentation.
CPT code 48400 is an add-on code used to describe the injection of a substance during an intraoperative procedure. This code indicates that a specific injection was administered to enhance the surgical process, typically to provide localized anesthesia, deliver medication, or facilitate a particular surgical technique. It is important to note that this code is used in conjunction with a primary surgical procedure code to provide a complete picture of the services rendered during the operation.
For CPT code 48400, "Injection intraop add-on," the following modifiers may be applicable:
1. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is an additional one performed in conjunction with other procedures.
2. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It is used to avoid bundling issues and to clarify that the procedures are separate and necessary.
3. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when the same procedure is repeated by the same physician. It indicates that the procedure was necessary to be performed more than once on the same day.
4. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when the same procedure is repeated by a different physician. It indicates that the procedure was necessary to be performed more than once on the same day by different providers.
5. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): This modifier is used when the patient returns to the operating room for a related procedure during the postoperative period of the initial surgery.
6. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.
7. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): This modifier is used when the same laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 48400, which is an injection intraop add-on, is subject to reimbursement by Medicare, but it is essential to verify its status on the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on whether specific CPT codes are covered and the reimbursement rates. Additionally, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) for any local coverage determinations or specific billing guidelines that may affect the reimbursement of CPT code 48400.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level, including specific codes like 48400, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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