CPT code 36145 is used for procedures involving the creation of a connection between an artery and a vein, often for dialysis access.
CPT code 36145 is used to describe the procedure of introducing a needle or catheter into an artery-to-vein shunt, which is often created for patients undergoing hemodialysis. This code is typically utilized when a healthcare provider needs to access the shunt for diagnostic or therapeutic purposes, such as drawing blood or administering medication. The procedure involves careful insertion to ensure proper function and maintenance of the shunt, which is crucial for patients who rely on it for regular dialysis treatments.
For CPT code 36145, which pertains to an artery to vein shunt, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the professional component of a service is being billed separately from the technical component. It indicates that the provider is billing for the interpretation of the procedure, not the procedure itself.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier is used to indicate that the service was performed bilaterally.
3. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same session. It indicates that more than one procedure was performed and helps in the correct allocation of payment.
4. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. It indicates that the service provided was less than usually required.
5. 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 prevent bundling of services that are typically considered inclusive.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure or service is repeated by another physician or qualified healthcare professional 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 related procedure is performed during the postoperative period of the initial procedure.
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.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure. It indicates that another surgeon assisted in the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
These modifiers help in providing additional information about the service performed and ensure accurate billing and reimbursement. It is important to choose the appropriate modifier based on the specific circumstances of the procedure.
CPT code 36145 is associated with procedures that may be reimbursed by Medicare, but whether it is reimbursed depends on several factors, including the specific circumstances of the procedure and the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers on a fee-for-service basis.
To determine if CPT code 36145 is reimbursed, healthcare providers should consult the MPFS to check if the code is listed and what the reimbursement rate is. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide guidance on coverage and reimbursement for specific CPT codes, including any local coverage determinations (LCDs) that might affect reimbursement.
Therefore, while CPT code 36145 may be reimbursed by Medicare, it is essential for healthcare providers to verify the specific reimbursement details through the MPFS and consult with their respective MAC to ensure compliance with any regional policies or requirements.
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