CPT code 38505 is a medical code used to describe a needle biopsy procedure for lymph nodes, helping to standardize healthcare documentation.
CPT code 38505 is a procedure code that describes the performance of a needle biopsy on lymph nodes, where a small sample of tissue is obtained using a fine needle for the purpose of examining potential conditions such as infections or cancer.
When dealing with CPT code 38505 for a needle biopsy of lymph nodes, there are several modifiers that may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their uses:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed, such as the interpretation of results by a physician.
2. Modifier TC - Technical Component: This is used when only the technical component of the service is being billed, such as the use of equipment and facilities.
3. Modifier 50 - Bilateral Procedure: If the needle biopsy is performed on lymph nodes on both sides of the body during the same session, this modifier is used to indicate a bilateral procedure.
4. 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.
5. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician on the same day, this modifier is used to indicate the repeat service.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the procedure is repeated by a different physician on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: If the patient needs to return to the operating or procedure room for a related procedure during the postoperative period, this modifier is applicable.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
9. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: If the biopsy needs to be repeated for clinical diagnostic purposes, this modifier is used to indicate the repeat test.
10. Modifier XS - Separate Structure: This modifier is used to indicate that a service was performed on a separate organ/structure.
11. Modifier XE - Separate Encounter: This is used when the procedure is performed during a separate encounter on the same day.
12. Modifier XP - Separate Practitioner: This modifier is used when the procedure is performed by a different practitioner.
13. Modifier XU - Unusual Non-Overlapping Service: This is used to indicate that the service does not overlap with other services provided.
These modifiers help provide additional information about the procedure and ensure accurate billing and reimbursement. It is important to select the appropriate modifier based on the specific circumstances of the procedure to avoid claim denials or delays.
The CPT code 38505 is reimbursed by Medicare, but its reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. However, the actual reimbursement for CPT code 38505 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and providing guidance on coverage and reimbursement policies within their jurisdiction. Therefore, healthcare providers should consult their local MAC for precise information regarding the reimbursement of CPT code 38505.
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