CPT code 39400 is a medical code used to describe a mediastinoscopy procedure that includes a biopsy for diagnostic purposes.
CPT code 39400 is a mediastinoscopy, including the collection of biopsy specimens, performed to assess mediastinal structures.
For CPT code 39400, which pertains to mediastinoscopy including biopsy, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the mediastinoscopy procedure required significantly more work than typically required. This could be due to unusual anatomy or complications during the procedure.
2. Modifier 51 - Multiple Procedures: If the mediastinoscopy 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 the mediastinoscopy was a distinct procedure from other services performed on the same day. It is applicable when procedures are not typically reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the mediastinoscopy due to its complexity, this modifier indicates that both surgeons are involved in the procedure.
5. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same physician performs a repeat mediastinoscopy procedure on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is applicable if a different physician performs a repeat mediastinoscopy on the same day.
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: If the patient needs to return to the operating room for a related procedure during the postoperative period, this modifier is used.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if the mediastinoscopy is performed during the postoperative period of another procedure but is unrelated to the initial surgery.
9. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required to help with the mediastinoscopy, this modifier indicates their involvement.
10. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is necessary for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident is not available.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 39400, which involves a specific medical procedure, is generally reimbursed by Medicare, provided that it meets the necessary coverage criteria and is deemed medically necessary. The reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B.
However, it's important to note that the reimbursement 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 guidelines for coverage and reimbursement in their respective jurisdictions. Therefore, healthcare providers should verify with their local MAC to ensure compliance with any additional requirements or documentation needed for reimbursement of CPT code 39400.
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