CPT code 38555 is a medical code used to describe the removal of a lesion from the neck or armpit area, helping to standardize healthcare documentation.
CPT code 38555 is used to bill for the surgical removal of a lesion found in the neck or armpit area.
For CPT code 38555, which involves the removal of a lesion in the neck or armpit area, 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 procedure required significantly more work than typically required. This could be due to unusual pathology, anatomical variations, or other complicating factors.
2. Modifier 50 (Bilateral Procedure): If the procedure was performed on both sides of the body (e.g., both armpits), this modifier should be used to indicate that the procedure was bilateral.
3. Modifier 51 (Multiple Procedures): Apply this modifier if multiple procedures were performed during the same surgical session. This helps indicate that more than one procedure was carried out.
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 particularly useful if the procedure was performed in a different anatomical site or was not typically performed together with other procedures.
5. Modifier 76 (Repeat Procedure by Same Physician): If the same procedure was repeated by the same physician on the same day, this modifier should be used to indicate the repetition.
6. Modifier 77 (Repeat Procedure by Another Physician): Use this modifier if the procedure was repeated on the same day by a different physician.
7. Modifier 78 (Unplanned Return to the Operating/Procedure Room): If the patient had to return to the operating room for a related procedure during the postoperative period, this modifier should be applied.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician): This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 80 (Assistant Surgeon): If an assistant surgeon was necessary for the procedure, this modifier should be used to indicate their involvement.
10. Modifier 82 (Assistant Surgeon when Qualified Resident Surgeon Not Available): Use this modifier if an assistant surgeon was required because a qualified resident was not available.
Each modifier serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. It's important to review the patient's medical record and the specifics of the procedure to determine which modifiers are appropriate.
CPT code 38555 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) is a crucial resource that outlines the payment rates for services covered under Medicare Part B, including those associated with CPT codes. To determine if CPT code 38555 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the associated reimbursement rate.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make local coverage determinations (LCDs) that can affect whether a specific CPT code is reimbursed in their jurisdiction. Therefore, it is essential for healthcare providers to check with their respective MAC to confirm if CPT code 38555 is covered and to understand any specific billing requirements or documentation needed for reimbursement.
In summary, while CPT code 38555 can be reimbursed by Medicare, providers must verify its inclusion in the MPFS and consult their MAC for any local coverage policies that may impact reimbursement.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 38555, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and 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
