CPT code 91105 is a code used to describe gastric intubation treatment for medical billing and documentation purposes.
CPT code 91105 is used to describe the procedure of gastric intubation treatment. This involves the insertion of a tube into the stomach to administer medications, fluids, or to remove gastric contents. It is typically performed in cases where a patient is unable to take substances orally or requires monitoring of gastric function.
For CPT code 91105, which pertains to gastric intubation treatment, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide a service is substantially greater than typically required. For example, if the gastric intubation treatment is more complex due to patient-specific factors, Modifier 22 would be appropriate.
2. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. If the gastric intubation treatment is not fully completed, Modifier 52 should be applied.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. If the gastric intubation treatment is performed separately from other procedures, Modifier 59 would be applicable.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when a procedure or service is repeated by the same physician. If the gastric intubation treatment needs to be repeated on the same day by the same provider, Modifier 76 should be used.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure or service is repeated by another physician. If the gastric intubation treatment is repeated on the same day by a different provider, Modifier 77 would be appropriate.
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: This modifier is used when a patient returns to the operating room for a related procedure during the postoperative period. If the gastric intubation treatment requires an unplanned return to the procedure room, Modifier 78 should be applied.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure or service performed during the postoperative period is unrelated to the original procedure. If the gastric intubation treatment is unrelated to the initial procedure, Modifier 79 would be appropriate.
8. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure. If an assistant surgeon is necessary for the gastric intubation treatment, Modifier 80 should be used.
9. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required. If a minimum assistant surgeon is needed for the gastric intubation treatment, Modifier 81 would be applicable.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available. If this situation applies to the gastric intubation treatment, Modifier 82 should be used.
11. 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. If such a professional assists in the gastric intubation treatment, Modifier AS would be appropriate.
These modifiers help provide additional information about the circumstances under which the gastric intubation treatment was performed, ensuring accurate billing and reimbursement.
CPT code 91105 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 guidelines related to CPT 91105.
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