CPT code 38900 is a medical code used to describe the imaging of a sentinel lymph node for diagnostic purposes.
CPT code 38900 is used to perform the mapping of the sentinel lymph node, where a radiolabeled agent is utilized to identify the primary lymph node that directly receives drainage from a specific tumor area. This procedure guides clinicians during surgery to locate the lymph node for targeted removal and subsequent pathological evaluation.
For CPT code 38900, which pertains to the intraoperative mapping of sentinel lymph nodes, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:
1. Modifier 26 - Professional Component: This modifier is used when the service provided is the professional component of a procedure that has both professional and technical components. It indicates that the physician's expertise was utilized in the interpretation of the mapping.
2. Modifier 50 - Bilateral Procedure: If the sentinel lymph node mapping is performed bilaterally, this modifier should be used to indicate that the procedure was performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the mapping was one of several procedures performed.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the mapping was a distinct service from other procedures performed on the same day. It is used to avoid bundling issues and to clarify that the mapping was a separate and necessary service.
5. Modifier 76 - Repeat Procedure by Same Physician: If the mapping needs to be repeated during the same operative session by the same physician, this modifier is used to indicate that the procedure was repeated.
6. Modifier 77 - Repeat Procedure by Another Physician: If the mapping is repeated by a different physician during the same operative session, this modifier is used.
7. 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.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if the mapping is performed during the postoperative period of another procedure but is unrelated to the initial surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to select the appropriate modifier based on the specific details of the procedure and the payer's guidelines.
CPT code 38900 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, along with the payment rates for each service. However, the actual reimbursement for CPT code 38900 can vary based on geographic location and other factors, as determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a particular region. Each MAC may have specific local coverage determinations (LCDs) that further define the circumstances under which CPT code 38900 is reimbursable. Therefore, healthcare providers should consult their local MAC for detailed information on coverage and reimbursement for this specific code.
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