CPT code 38211 is a medical code used to describe the process of harvesting tumor cells for analysis or treatment.
CPT code 38211 is used to describe the process of removing tumor cells from a harvested sample, typically to lower the risk of reintroducing malignant cells during treatments such as autologous transplantation.
For CPT code 38211, which involves tumor cell depletion of a harvest, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier can be used if the procedure required significantly more effort or time than typically expected. Documentation must support the increased complexity.
2. Modifier 52 (Reduced Services): If the procedure was partially reduced or eliminated at the discretion of the physician, this modifier can be applied to indicate that the service provided was less than usually required.
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 often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 76 (Repeat Procedure by Same Physician): If the same procedure is repeated by the same physician, this modifier can be used to indicate that the service was performed more than once on the same day.
5. Modifier 77 (Repeat Procedure by Another Physician): Similar to Modifier 76, but used when the repeat procedure is performed by a different physician.
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 applicable if the patient needs to return 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): This is used when a procedure performed during the postoperative period is unrelated to the original procedure.
8. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): If the procedure involves a laboratory test that needs to be repeated for clinical reasons, this modifier can be used to indicate the necessity of the repeat test.
Each modifier should be used in accordance with the specific circumstances of the procedure and must be supported by appropriate documentation in the patient's medical record. Proper use of modifiers can ensure accurate billing and reimbursement.
CPT code 38211 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set by the Medicare Administrative Contractor (MAC) in your region. The MPFS provides a list of services covered by Medicare and assigns a relative value to each service, which influences reimbursement rates. However, coverage can vary based on local policies established by the MAC, which administers Medicare claims and determines coverage specifics in different geographic areas. Therefore, to determine if CPT code 38211 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and verify with their local MAC for any additional coverage criteria or restrictions that may apply.
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