CPT code 38102 is used to identify the procedure for the total removal of the spleen, helping healthcare providers document and communicate services accurately.
CPT code 38102 is a procedure code used to indicate the complete removal of the spleen.
For CPT code 38102, which pertains to the removal of the spleen, total, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: This modifier is 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: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that multiple procedures were performed, and it may affect reimbursement.
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. It is used to identify procedures that are not normally reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure. Each surgeon should report their distinct operative work.
5. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the services of a surgical team. Documentation should support the necessity of a team approach.
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 requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure performed during the postoperative period is unrelated to the original procedure.
8. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required during the procedure. The assistant surgeon provides additional support to the primary surgeon.
9. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required on a limited basis during the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required, and a qualified resident surgeon is not available.
Each of these modifiers serves a specific purpose and should be used in accordance with the documentation and circumstances surrounding the procedure. Proper use of modifiers ensures accurate billing and reimbursement.
CPT code 38102, which involves the removal of the spleen, is typically reimbursed by Medicare, provided that the procedure is deemed medically necessary and meets all coverage criteria. The reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services rendered by physicians and other healthcare providers.
To ensure accurate reimbursement, healthcare providers must verify the specific coverage details with their respective Medicare Administrative Contractor (MAC). MACs are responsible for processing Medicare claims and can provide guidance on any regional variations or additional documentation requirements that may affect the reimbursement of CPT code 38102. It is crucial for providers to stay informed about any updates to the MPFS and MAC guidelines to ensure compliance and optimize revenue cycle management.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including CPT code 38102, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
