CPT code 38381 is a medical code used to describe a specific procedure involving the thoracic duct, helping healthcare providers document services accurately.
CPT code 38381 is a procedure that involves surgical intervention on the thoracic duct, often used to manage issues like chyle leaks by ligating or repairing the duct during thoracic surgery.
For CPT code 38381, which pertains to a thoracic duct procedure, 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. This could be due to increased complexity or difficulty of the procedure.
2. Modifier 51 - Multiple Procedures: If the thoracic duct procedure is performed in conjunction with other procedures during the same surgical session, this modifier indicates that multiple procedures were performed.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is 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 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are actively involved and each is performing a distinct part of the procedure.
5. Modifier 66 - Surgical Team: When a highly complex procedure requires the skills of several physicians or other qualified healthcare professionals, this modifier is used to indicate that a surgical team was necessary.
6. Modifier 76 - Repeat Procedure by Same Physician: If the procedure needs to be repeated by the same physician, this modifier is used to indicate that the repeat procedure was necessary.
7. Modifier 77 - Repeat Procedure by Another Physician: Similar to Modifier 76, but used when the repeat procedure is performed by a different physician.
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 if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure, this modifier is used.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help perform the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon is required for a minimal portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary due to the unavailability of a qualified resident.
13. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the procedure, this modifier indicates that multiple modifiers are being used.
These modifiers help provide additional information about the circumstances under which the thoracic duct procedure was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines, as modifier usage can vary between insurance carriers.
CPT code 38381 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 policies of the local Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates. However, coverage and reimbursement can vary based on the MAC, which administers Medicare claims for specific regions and may have additional guidelines or requirements for certain procedures. Therefore, to determine if CPT code 38381 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and verify any specific local coverage determinations or policies set forth by their regional MAC.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 38381, and by individual payer. Don't let underpayments slip through the cracks—schedule a demo today to see how RevFind can optimize your revenue cycle management.
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
