CPT code 38780 is used to describe the procedure for removing lymph nodes from the abdomen, helping to document surgical interventions.
CPT code 38780 is used to indicate the surgical removal of lymph nodes from the abdominal area.
For the CPT code 38780, 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: If the removal of abdominal 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 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 applicable when a highly complex procedure requires the skills of several physicians, often from different specialties, working together as a team.
6. 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 needs to return to the operating room for a related procedure during the postoperative period.
7. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required to help with the procedure, this modifier is used to indicate their involvement.
8. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Similar to Modifier 80, but used when a qualified resident surgeon is not available, necessitating the use of an assistant surgeon.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 38780 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 specific guidelines set forth by the Medicare Administrative Contractor (MAC) for the region in which the service is provided. The MPFS outlines the payment rates for services covered by Medicare, and each MAC may have additional local coverage determinations that affect reimbursement. Therefore, healthcare providers should verify the reimbursement status of CPT code 38780 by consulting the MPFS and the relevant MAC's policies to ensure compliance and accurate billing.
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