CPT code 38120 is a medical code used to describe a laparoscopic splenectomy, which is the surgical removal of the spleen using minimally invasive techniques.
CPT code 38120 is used to report a minimally invasive surgical procedure for removing the spleen using laparoscopy.
For CPT code 38120, which pertains to a laparoscopic splenectomy, 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 is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
3. Modifier 52 - Reduced Services: This modifier is applicable when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Used 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: This is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier is used to indicate that both surgeons are primary surgeons.
7. Modifier 66 - Surgical Team: This is used when a team of surgeons is required to perform the procedure due to its complexity.
8. 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 the patient requires a return to the operating room for a related procedure during the postoperative period.
9. Modifier 80 - Assistant Surgeon: This is used when an assistant surgeon is required to help perform the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement. It is important to review the specific payer guidelines, as they may have unique requirements for modifier usage.
The CPT code 38120 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in establishing the payment rates for services rendered under this code. However, the actual reimbursement can vary based on geographic location and specific local policies, which are managed by the Medicare Administrative Contractors (MACs). These contractors are responsible for processing claims and ensuring that the services meet Medicare's coverage criteria. Therefore, while CPT code 38120 is generally reimbursable under Medicare, healthcare providers should verify the specific reimbursement details with their respective MAC to ensure compliance and accurate payment.
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 specific codes like 38120. Schedule a demo today to see how RevFind can help you ensure full reimbursement from each payer.
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