CPT code 38562 is a medical code used to describe the procedure for removing pelvic lymph nodes during surgery.
CPT code 38562 is used for the removal of pelvic lymph nodes during a surgical procedure.
For CPT code 38562, which pertains to the removal of pelvic lymph nodes, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when 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 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
3. 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 used to identify procedures that are not normally reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure. Each surgeon should report their distinct operative work.
5. Modifier 66 - Surgical Team: This modifier is used when a team of surgeons is required to perform a complex procedure. Documentation should support the necessity of a team approach.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician subsequent to the original procedure.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician subsequent to 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 requires a 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: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to assist the primary surgeon during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required on a minimal basis.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
13. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided.
Each modifier should be used in accordance with payer guidelines and supported by appropriate documentation to justify its use.
CPT code 38562, which involves the removal of pelvic lymph nodes, is reimbursed by Medicare, provided it meets the necessary coverage criteria and is deemed medically necessary. The reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B.
To ensure accurate reimbursement, healthcare providers must verify the specific coverage details and payment rates with their respective Medicare Administrative Contractor (MAC). MACs are responsible for processing Medicare claims and can provide guidance on any local coverage determinations or additional documentation requirements that may apply to CPT code 38562. It is crucial for providers to stay informed about any updates or changes to the MPFS and MAC guidelines to ensure compliance and optimize reimbursement.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including specific codes like 38562. Schedule a demo today to see how RevFind can help you maximize reimbursements from each payer.
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