CPT code 50130 is for a surgical procedure involving the removal of a kidney stone through an incision in the renal pelvis.
CPT code 50130 is a medical billing code used to describe a surgical procedure known as a pyelotomy with the removal of a calculus, also referred to as pyelolithotomy or pelviolithotomy. This procedure involves making an incision into the renal pelvis, which is part of the kidney, to remove kidney stones (calculi). The process may also include coagulum pyelolithotomy, where a blood clot is used to help remove the stone. This code is utilized by healthcare providers to accurately document and bill for this specific surgical intervention in the treatment of kidney stones.
For CPT code 50130, which involves a pyelotomy with removal of calculus, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was performed.
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 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.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is used when the same procedure is repeated by a different provider.
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 when a patient requires a 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 is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with current coding guidelines and payer-specific requirements, as these can change.
The CPT code 50130 is reimbursed by Medicare, but the reimbursement is subject to several factors.
The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered under Medicare Part B, including surgical procedures like those associated with CPT code 50130.
The reimbursement amount can vary based on geographic location and other factors determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a specific region.
Each MAC may have slightly different policies or interpretations, so it is essential for healthcare providers to verify the specific reimbursement details with their local MAC.
Additionally, coverage and reimbursement can be influenced by whether the procedure is deemed medically necessary and if all Medicare billing requirements are met.
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