CPT code 36147 is used for procedures involving the evaluation of an arteriovenous dialysis graft for access.
CPT code 36147 is used to describe the procedure of accessing an arteriovenous (AV) dialysis graft for evaluation. This code is typically utilized when a healthcare provider needs to assess the functionality or condition of an AV graft, which is a connection made between an artery and a vein, often used in patients undergoing hemodialysis. The evaluation may involve imaging techniques to ensure the graft is functioning properly and to identify any potential issues such as blockages or narrowing that could affect dialysis treatment.
For CPT code 36147, which involves accessing an arteriovenous (AV) dialysis graft for evaluation, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed, such as the interpretation of the procedure without the technical component.
2. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier indicates that the service provided was less than usually required.
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 by Same Physician: If the same procedure is repeated by the same physician on the same day, this modifier is used to indicate the repetition.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated by a different physician on the same day.
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 related procedure is performed during the postoperative period of the initial procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is applicable when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
8. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier indicates their involvement.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is necessary due to the unavailability of a qualified resident.
10. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the service, this modifier indicates the use of multiple modifiers.
Each modifier serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies to ensure accurate billing and reimbursement.
CPT code 36147 is reimbursed by Medicare, but its 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 36147 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 local coverage determinations, which can influence whether and how much Medicare reimburses for this particular code.
Therefore, healthcare providers should consult their specific MAC for detailed information on reimbursement rates and any additional requirements that may apply to CPT code 36147.
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