CPT code 38770 is a medical code used to describe the procedure of removing pelvic lymph nodes for diagnostic or treatment purposes.
CPT code 38770 is the code used to describe a surgical procedure that removes one or more lymph nodes from the pelvic region to help diagnose or treat a medical condition.
When using CPT code 38770 for the removal of pelvic lymph nodes, 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: 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: If multiple procedures are performed during the same surgical session, this modifier indicates that the procedure was 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: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that each surgeon performed 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 due to its complexity.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used if the same procedure is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used if the procedure is repeated by a different provider.
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 if the patient returns 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.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required for the procedure.
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.
Each modifier should be used in accordance with the specific circumstances of the procedure and the payer's guidelines. Proper documentation is essential to support the use of any modifier.
CPT code 38770 is associated with the removal of pelvic lymph nodes. Whether this code is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) for the region in which the service is provided.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. If CPT code 38770 is listed in the MPFS, it indicates that Medicare has established a reimbursement rate for this service, subject to any applicable coverage policies.
However, the final determination of reimbursement also involves the MAC, which is responsible for processing Medicare claims and making coverage decisions based on national and local policies. Each MAC may have specific local coverage determinations (LCDs) that can affect whether a particular service, such as one billed under CPT code 38770, is reimbursed.
Therefore, to ascertain if CPT code 38770 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and review any relevant LCDs issued by their regional MAC. This ensures compliance with both national and local Medicare policies.
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