CPT code 39402 is a medical code used to describe a mediastinoscopy procedure with lymph node biopsy, helping healthcare providers document services.
CPT code 39402 is used to identify a procedure where a mediastinoscopy is performed along with a biopsy of one or more lymph nodes in the mediastinal area to help diagnose or rule out diseases.
For CPT code 39402, which pertains to mediastinoscopy with lymph node 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 procedure required significantly more work than typically required. This could be due to unusual anatomy or extensive disease.
2. Modifier 51 (Multiple Procedures): Apply this modifier if multiple procedures were performed during the same surgical session. This 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): If two surgeons are required to perform the procedure due to its complexity, this modifier should be used to indicate that both surgeons are actively involved.
5. Modifier 80 (Assistant Surgeon): Use this modifier if an assistant surgeon is necessary to complete the procedure.
6. Modifier 81 (Minimum Assistant Surgeon): This is used when an assistant surgeon is required for a minimal portion of the procedure.
7. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is applicable when an assistant surgeon is necessary, and a qualified resident is not available.
8. Modifier LT (Left Side) or RT (Right Side): These modifiers are used to specify the side of the body on which the procedure was performed, if applicable.
9. Modifier 99 (Multiple Modifiers): If multiple modifiers are necessary to describe the service, this modifier indicates that more than one modifier is being used.
Each of these modifiers serves a specific purpose and should be applied according to the specific details of the procedure and the payer's guidelines. Proper use of modifiers ensures accurate billing and reimbursement.
CPT code 39402, which involves a specific medical procedure, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in determining whether this code is reimbursed. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals, and it is updated annually to reflect changes in practice costs and policy adjustments.
To ascertain if CPT code 39402 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and what the associated reimbursement rate is. Additionally, Medicare Administrative Contractors (MACs) are responsible for processing Medicare claims and can provide further guidance on coverage specifics. MACs may have local coverage determinations (LCDs) that affect whether certain procedures, including those billed under CPT code 39402, are reimbursed in specific regions.
Therefore, while CPT code 39402 can be reimbursed by Medicare, it is essential for healthcare providers to review the MPFS and consult with their respective MAC to ensure compliance with any regional policies or requirements that may influence reimbursement.
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