CPT code 48511 is used to describe the procedure for draining a pancreatic pseudocyst in healthcare settings.
CPT code 48511 is used to describe the procedure of draining a pancreatic pseudocyst. This code specifically refers to the surgical intervention where a healthcare provider accesses and removes fluid from a cyst that has formed in the pancreas, which can occur due to inflammation or injury. The procedure aims to alleviate symptoms and prevent complications associated with the pseudocyst.
For CPT code 48511, which pertains to the drainage of a pancreatic pseudocyst, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that increased the complexity of the procedure.
2. Modifier 26 - Professional Component
- This modifier is used when only the professional component of the service is being billed, typically in cases where the procedure involves both a professional and a technical component.
3. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both sides of the body during the same session.
4. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
5. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
6. Modifier 53 - Discontinued Procedure
- Apply this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
7. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
8. Modifier 62 - Two Surgeons
- This modifier is used when two surgeons work together as primary surgeons performing distinct parts of the procedure.
9. Modifier 66 - Surgical Team
- Apply this modifier when a team of surgeons is required to perform the procedure due to its complexity.
10. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician repeats the procedure on the same day.
11. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when a different physician repeats the procedure on the same day.
12. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
13. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier when the procedure is unrelated to the original procedure and is performed during the postoperative period.
14. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required for the procedure.
15. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier when a minimum assistant surgeon is required for the procedure.
16. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is required because a qualified resident surgeon is not available.
17. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used 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.
CPT code 48511 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 the specific Medicare Administrative Contractor (MAC) and local coverage determinations. Providers should consult their regional MAC for specific coverage and payment information related to CPT 48511.
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