CPT code 34111 is used for the procedure involving the removal of a clot from an artery in the arm, aiding in restoring proper blood flow.
CPT code 34111 is used to describe the surgical procedure for the removal of a clot from an artery in the arm. This procedure is typically performed to restore normal blood flow when a clot has obstructed an artery, potentially causing pain, swelling, or other complications. The code is used by healthcare providers to document and bill for this specific service, ensuring accurate reimbursement and record-keeping within the healthcare revenue cycle.
For CPT code 34111, which pertains to the removal of an arm artery clot, 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 increased complexity or difficulty of the procedure.
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 used to identify procedures that are not normally reported together but are appropriate under the circumstances.
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): If the procedure requires a surgical team due to its complexity, this modifier is used to indicate that a team of surgeons was necessary.
6. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when the same procedure is repeated by the same physician subsequent to the original procedure.
7. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when the same procedure is repeated by a different physician subsequent to the original procedure.
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 an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It's important to review the specific guidelines and payer policies when applying modifiers to ensure compliance and proper claims processing.
CPT code 34111, which involves the removal of an arm artery clot, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines whether a specific CPT code is reimbursable and at what rate. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals under Medicare Part B.
To ascertain if CPT code 34111 is reimbursed, healthcare providers should consult the MPFS to verify its inclusion and the associated reimbursement rate. Additionally, Medicare Administrative Contractors (MACs) play a pivotal role in this process. MACs are responsible for processing Medicare claims and have the authority to make determinations regarding coverage and reimbursement for specific services within their jurisdiction.
Therefore, while CPT code 34111 may be listed in the MPFS, providers should also check with their respective MAC to ensure that there are no local coverage determinations (LCDs) or other specific guidelines that might affect reimbursement. This dual verification process helps ensure that the service is covered and reimbursed appropriately under Medicare.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including CPT code 34111, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
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