CPT code 38792 is a medical code used to identify the procedure of using a radioactive tracer to locate sentinel lymph nodes.
CPT code 38792 is used for the injection of a radioactive tracer to locate the sentinel lymph node during a procedure.
For CPT code 38792, which involves the identification of a sentinel node using a radiopharmaceutical tracer, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the procedure, not the technical component.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the use of equipment, supplies, and technical staff.
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 may be necessary if the sentinel node identification is performed in conjunction with other procedures that are not typically reported together.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same provider. It may be applicable if the sentinel node identification needs to be repeated during the same session.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by a different provider. It may be applicable if the sentinel node identification is repeated by another provider during the same session.
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 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 the procedure is unrelated to the original.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the circumstances under which the procedure was performed. It is important for healthcare providers to select the appropriate modifiers to avoid claim denials and ensure compliance with payer requirements.
CPT code 38792 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 corresponding payment rates. However, it's important to note that the reimbursement for CPT code 38792 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national Medicare policies and establish local coverage determinations, which can influence whether and how a particular service is reimbursed. Therefore, healthcare providers should consult their specific MAC for detailed information regarding the reimbursement of CPT code 38792 in their region.
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