CPT code 36120 is used for procedures involving the establishment of access to an artery, crucial for various diagnostic and therapeutic interventions.
CPT code 36120 is used to describe the procedure of establishing access to an artery. This involves the insertion of a needle or catheter into an artery, typically for diagnostic or therapeutic purposes. The procedure is often a preliminary step in various vascular interventions or diagnostic studies, allowing healthcare providers to administer medications, contrast agents, or to measure arterial pressure directly. This code is crucial for accurate billing and documentation in the healthcare revenue cycle, ensuring that the services provided are appropriately recorded and reimbursed.
For CPT code 36120, which involves establishing access to an artery, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body during the same session.
2. Modifier 51 - Multiple Procedures: This is applied when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
3. Modifier 52 - Reduced Services: This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 59 - Distinct Procedural Service: This is used to indicate that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: This is used when the same procedure is repeated by a different physician 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: This modifier is used if the patient returns to the operating room for a related procedure during the postoperative period.
8. 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 the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 36120 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the payment rates for each service.
However, the actual reimbursement for CPT code 36120 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). MACs are responsible for processing Medicare claims and have the authority to interpret and apply Medicare coverage policies, which can influence the reimbursement process for specific CPT codes like 36120.
Therefore, healthcare providers should consult their local MAC for detailed information on reimbursement rates and any additional requirements for CPT code 36120.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including CPT code 36120, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
