CPT code 38745 is a medical code used to identify the procedure of removing lymph nodes from the armpit area for healthcare documentation and processing.
CPT code 38745 is used to describe a procedure in which a surgeon removes lymph nodes from the armpit area.
For CPT code 38745, which involves the removal of armpit lymph nodes, the following modifiers may be applicable depending on the specific circumstances of the procedure:
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: If the removal of armpit lymph nodes is performed in conjunction with other procedures during the same surgical session, this modifier indicates that multiple procedures were performed.
3. 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.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure, this modifier is applicable.
5. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required to help with the procedure, this modifier is used to indicate their involvement.
6. Modifier 81 - Minimum Assistant Surgeon: This is used when an assistant surgeon is required for a portion of the procedure.
7. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when a qualified resident surgeon is not available, and an assistant surgeon is necessary.
8. Modifier LT - Left Side: If the procedure is performed on the left side of the body, this modifier specifies the location.
9. Modifier RT - Right Side: Similarly, if the procedure is performed on the right side of the body, this modifier indicates the location.
10. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the service, this modifier is used to indicate that multiple modifiers apply.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies to ensure accurate billing and reimbursement.
CPT code 38745 is subject to reimbursement by Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the specific Medicare Administrative Contractor (MAC) that processes claims in your region. The MPFS provides a comprehensive list of services covered by Medicare, along with the payment rates for each service. However, the final determination of reimbursement is often influenced by the local coverage determinations (LCDs) set forth by the MACs, which can vary by geographic area. Therefore, it is crucial for healthcare providers to verify the coverage and reimbursement specifics for CPT code 38745 with their respective MAC to ensure compliance and proper billing practices.
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