CPT code 38308 is a medical code used to describe the procedure of making an incision in lymph channels for treatment purposes.
CPT code 38308 is used to document the surgical procedure involving the incision of lymph channels.
For CPT code 38308, "Incision of lymph channels," the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if 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 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier should be used to indicate that the procedure was bilateral.
3. Modifier 51 - Multiple Procedures: Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed.
4. Modifier 52 - Reduced Services: Use this modifier when the procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reduction in services.
5. 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 identify procedures that are not typically reported together but are appropriate under the circumstances.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Use this modifier if the procedure is repeated by the same provider subsequent to the original procedure.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when a procedure is repeated by a different provider than the one who performed the original procedure.
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 a patient returns to the operating room for a related procedure during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician provider assists in the surgery.
These modifiers should be applied based on the specific details of the procedure and the circumstances under which it was performed. Proper documentation is essential to support the use of any modifier.
CPT code 38308, which pertains to the incision of lymph channels, is subject to reimbursement considerations under Medicare. To determine if this specific CPT code is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare, including whether a particular CPT code is reimbursable and the associated reimbursement amount.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific guidance on coverage and reimbursement for CPT codes like 38308. Providers should consult their local MAC to confirm the reimbursement status of CPT code 38308, as policies and coverage can vary by region.
In summary, while CPT code 38308 may be listed in the MPFS, the final determination of reimbursement will depend on the guidelines and policies set forth by the relevant MAC. Healthcare providers are encouraged to verify with their MAC to ensure accurate billing and reimbursement for this procedure.
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