CPT code 39220 is a medical code used to describe the surgical removal of a tumor located in the mediastinum, the area between the lungs.
CPT code 39220 is used to identify the procedure for resecting a tumor located in the mediastinum, which is the central compartment of the thoracic cavity.
When using CPT code 39220 for the resection of a mediastinal tumor, 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 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 more than one procedure was carried out.
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): When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is used to indicate the collaborative effort.
5. Modifier 66 (Surgical Team): This modifier is applicable when a complex procedure requires the services of a surgical team.
6. Modifier 76 (Repeat Procedure by Same Physician): If the same physician repeats the procedure on the same day, this modifier is used to indicate the repetition.
7. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a procedure is repeated by a different physician on the same day.
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 when a patient requires a return 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 a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
10. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required during the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): This modifier indicates that a minimum assistant surgeon was required for the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
Each modifier serves a specific purpose and should be used in accordance with the guidelines set forth by the American Medical Association (AMA) and payer-specific policies. Proper documentation is essential to justify the use of any modifier.
The CPT code 39220, which involves the resection of a mediastinal tumor, is reimbursed by Medicare, provided it meets the necessary criteria outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used to reimburse physicians and other healthcare providers for services rendered to Medicare beneficiaries.
However, the reimbursement for CPT code 39220 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting specific reimbursement rates within their jurisdiction, ensuring that the services billed align with Medicare's coverage policies and guidelines.
Therefore, healthcare providers should verify the specific reimbursement details with their respective MAC to ensure compliance and accurate billing.
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