CPT code 38564 is a medical code used to describe the procedure for removing lymph nodes from the abdomen.
CPT code 38564 is used for the surgical removal of one or more lymph nodes from the abdominal area for diagnostic or therapeutic purposes.
For CPT code 38564, which involves the removal of abdominal 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. This could be due to factors such as increased complexity or time.
2. Modifier 51 - Multiple Procedures: This modifier is applicable when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed on the same day.
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 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 each surgeon is performing a distinct part of the procedure.
5. Modifier 66 - Surgical Team: This modifier is used when a team of surgeons is required to perform the procedure, indicating that the complexity of the procedure necessitates a team approach.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same physician repeats the procedure on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a different physician repeats the procedure on the same day.
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 the 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 a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to assist with 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.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
The CPT code 38564 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 the associated payment rates. However, the actual reimbursement for CPT code 38564 can vary based on several factors, including geographic location and the specific policies of the Medicare Administrative Contractor (MAC) responsible for processing claims in that region. Each MAC may have unique coverage determinations and guidelines that influence whether and how a particular service is reimbursed. Therefore, healthcare providers should consult their local MAC for detailed information on the reimbursement criteria and any additional documentation requirements for CPT code 38564.
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