CPT code 36245 is used for describing the procedure of inserting a catheter into the abdominal or lower extremity artery for the first time.
CPT code 36245 is used to describe the procedure of inserting a catheter into the abdominal or lower extremity artery for the first time. This code is specifically utilized when a healthcare provider performs a selective catheterization, meaning the catheter is guided into a specific artery within the abdominal or lower extremity region to either diagnose or treat a condition. This procedure is often part of a larger diagnostic or interventional process, such as an angiogram, where detailed images of the blood vessels are needed to assess for blockages or other vascular issues.
For CPT code 36245, which involves the catheterization of an abdominal or lower extremity artery, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. It indicates that the physician's interpretation and report are being billed separately from the technical component.
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 helps in identifying that more than one procedure was conducted.
4. 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.
5. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician, this modifier is used to indicate that the procedure was repeated.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the procedure is repeated 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 when 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 modifier is 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: This modifier is used when an assistant surgeon is required for the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
These modifiers help in providing additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 36245 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that outlines the payment rates for services covered by Medicare. To determine if CPT code 36245 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the associated reimbursement rate.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide specific guidance on whether CPT code 36245 is covered in a particular region, as coverage can vary based on local policies and medical necessity criteria. Providers should check with their respective MAC to ensure compliance with any local coverage determinations (LCDs) that might affect the reimbursement of this code.
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