CPT code 49180 is a medical billing code used for billing an abdominal mass biopsy procedure in healthcare settings.
CPT code 49180 is used to describe a biopsy procedure performed on an abdominal mass. This code indicates that a healthcare provider has taken a sample of tissue from a mass located in the abdominal area for diagnostic purposes. The biopsy helps in determining whether the mass is benign or malignant, guiding further treatment decisions.
When billing for CPT code 49180 (Biopsy, abdominal mass), it is essential to consider the appropriate modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 49180, along with the reasons for their use:
1. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, typically by the physician who interprets the results.
2. Modifier TC - Technical Component: Used when only the technical component of the service is being billed, typically by the facility where the procedure is performed.
3. Modifier 59 - Distinct Procedural Service: Used to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician on the same day.
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: Used when the patient returns to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Used when the same laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
9. Modifier LT - Left Side: Used to indicate that the procedure was performed on the left side of the body.
10. Modifier RT - Right Side: Used to indicate that the procedure was performed on the right side of the body.
11. Modifier XS - Separate Structure: Used to indicate that a service is distinct because it was performed on a separate organ/structure.
12. Modifier XE - Separate Encounter: Used to indicate that a service is distinct because it was performed during a separate encounter.
13. Modifier XP - Separate Practitioner: Used to indicate that a service is distinct because it was performed by a different practitioner.
14. Modifier XU - Unusual Non-Overlapping Service: Used to indicate that a service is distinct because it does not overlap usual components of the main service.
These modifiers help clarify the specifics of the procedure performed and ensure that the billing is accurate and compliant with payer policies. Always verify with the specific payer guidelines to ensure the correct use of modifiers.
CPT code 49180 is reimbursed by Medicare. The code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, coverage and reimbursement 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 related to this procedure.
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