CPT code 38542 is used to describe the procedure of exploring deep node(s) in the neck for diagnostic purposes.
CPT code 38542 is used to describe the surgical exploration of deep cervical lymph nodes, typically performed to evaluate abnormal tissue identified through physical examination or imaging studies. This procedure may include the collection of tissue samples for further pathological analysis to help diagnose conditions such as infection or malignancy.
When using CPT code 38542 for exploring deep node(s) in the neck, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their reasons for use:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly more work than typically required. This could be due to unusual anatomy or extensive disease involvement.
2. Modifier 50 (Bilateral Procedure): If the procedure is performed on both sides of the neck, this modifier indicates that the service 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 59 (Distinct Procedural Service): Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. Modifier 62 (Two Surgeons): If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons had a significant role.
6. Modifier 76 (Repeat Procedure by Same Physician): Use this modifier if the same procedure is repeated by the same physician on the same day.
7. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when the procedure is repeated by a different physician on the same day.
8. Modifier 78 (Unplanned Return to the Operating/Procedure Room): If the patient needs to return to the operating room for a related procedure during the postoperative period, this modifier is applicable.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Use this modifier when the procedure is unrelated to the original surgery and occurs during the postoperative period.
10. Modifier 80 (Assistant Surgeon): If an assistant surgeon is necessary for the procedure, this modifier indicates their involvement.
11. Modifier 82 (Assistant Surgeon - When Qualified Resident Surgeon Not Available): This modifier is used when an assistant surgeon is required because a qualified resident is not available.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always refer to the latest coding guidelines and payer-specific policies when applying modifiers.
CPT code 38542 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 covered under Medicare Part B, including those represented by CPT codes. To determine if CPT code 38542 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the associated payment rate.
Additionally, Medicare Administrative Contractors (MACs) are responsible for processing claims and making coverage determinations at the regional level. Each MAC may have specific Local Coverage Determinations (LCDs) that can affect whether CPT code 38542 is reimbursed in their jurisdiction. Therefore, it is essential for healthcare providers to check with their respective MAC to confirm the reimbursement status of CPT code 38542 and to ensure compliance with any local policies or documentation requirements that may apply.
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