CPT code 59514 is for a cesarean delivery procedure, used by healthcare providers to document and categorize this specific medical service.
CPT code 59514 is used to describe a cesarean delivery procedure. This code specifically refers to the surgical delivery of a baby through an incision made in the mother's abdomen and uterus. It is important to note that this code covers only the delivery aspect of the cesarean section and does not include any antepartum or postpartum care. Healthcare providers use this code to bill for the surgical service provided during the cesarean delivery.
For CPT code 59514, which pertains to cesarean delivery only, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as unusual patient anatomy or complications during the cesarean delivery.
2. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the cesarean delivery was one of several procedures performed.
3. Modifier 52 (Reduced Services): Used when a service or procedure is partially reduced or eliminated at the physician's discretion. This might apply if the cesarean delivery was not completed as initially planned.
4. Modifier 59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This could be relevant if the cesarean delivery was performed in conjunction with other unrelated procedures.
5. Modifier 76 (Repeat Procedure by Same Physician): Used when the same procedure is repeated by the same physician. This might apply if a repeat cesarean delivery is necessary within a short time frame.
6. Modifier 77 (Repeat Procedure by Another Physician): Similar to Modifier 76, but used when the repeat procedure is performed by a different physician.
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 requires an unplanned return to the operating room for a related procedure during the postoperative period of the initial cesarean delivery.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
9. Modifier 80 (Assistant Surgeon): Indicates that an assistant surgeon was required during the cesarean delivery.
10. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon was necessary for the procedure.
11. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Applied when an assistant surgeon is required because a qualified resident surgeon is not available.
12. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Used when a non-physician practitioner assists in the surgery.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines set forth by the American Medical Association and payer policies to ensure accurate billing and reimbursement.
CPT code 59514 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services covered under Medicare Part B, and CPT code 59514 is listed with an assigned relative value unit (RVU) that determines its reimbursement rate. However, it's important to note that 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 payment policies within their jurisdiction, so healthcare providers should verify the reimbursement details with their respective MAC to ensure accurate billing and payment.
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