CPT code 48520 is used to describe the procedure of fusing a pancreatic cyst with the bowel for treatment purposes.
CPT code 48520 is used to describe the surgical procedure of fusing a pancreatic cyst to the bowel. This procedure typically involves creating a connection between the cyst and the bowel to allow for drainage and to alleviate symptoms associated with the cyst, such as pain or discomfort. It is often performed when the cyst is causing complications or is at risk of becoming problematic.
For CPT code 48520, 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. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
3. Modifier 52 (Reduced Services): Used when a service or procedure is partially reduced or eliminated at the physician's discretion. Documentation should explain why the service was reduced.
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 modifier is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
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 is carried out by a surgical team, typically involving several physicians, technicians, and other support staff.
8. Modifier 76 (Repeat Procedure by Same Physician): Used to indicate that a procedure or service was repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
9. Modifier 77 (Repeat Procedure by Another Physician): Applied when a procedure or service is repeated by another physician or other qualified healthcare professional 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): Used 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): Applied when a procedure or service performed during the postoperative period is unrelated to the original procedure.
12. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required during the procedure.
13. Modifier 81 (Minimum Assistant Surgeon): Applied when an assistant surgeon is required for a minimal portion of the procedure.
14. 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.
15. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Applied when a physician assistant, nurse practitioner, or clinical nurse specialist assists in surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 48520 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS) and is eligible for payment. However, coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. Healthcare providers should consult their local MAC for detailed coverage guidelines and any potential limitations or requirements for billing this code.
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