CPT code 48500 is a medical billing code used for the surgical treatment of pancreatic cysts, helping providers accurately document and bill for services.
CPT code 48500 is used to describe the surgical procedure for the removal or treatment of a pancreatic cyst. This code specifically pertains to interventions aimed at addressing cystic formations in the pancreas, which may involve techniques such as drainage or excision to alleviate symptoms or prevent complications.
For CPT code 48500, which pertains to the surgery of a pancreatic cyst, 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.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session.
3. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Applied when a procedure is terminated 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 requires the services of several physicians, often of different specialties, plus other highly skilled personnel.
8. Modifier 76 - Repeat Procedure or Service by Same Physician: Applied when a procedure or service is repeated by the same physician subsequent to the original procedure or service.
9. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician subsequent to the original procedure or service.
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 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: Used when a procedure or service performed during the postoperative period is unrelated to the original 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 these non-physician practitioners assist in surgery.
These modifiers help provide additional information about the circumstances under which the surgery of a pancreatic cyst was performed, ensuring accurate billing and reimbursement.
The CPT code 48500 is reimbursed by Medicare, but the reimbursement specifics can vary. To determine if CPT code 48500 is covered and the exact reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare. Additionally, it is essential to consult with the local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide region-specific guidance on coverage and reimbursement for CPT code 48500.
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 48500. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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