CPT code 36247 is used for a procedure involving the insertion of a catheter into the abdominal or lower extremity artery at a third order branch.
CPT code 36247 is used to describe the procedure of inserting a catheter into the abdominal or lower extremity artery and advancing it to a third-order or higher branch. This code is typically utilized in interventional radiology or vascular procedures where detailed imaging or treatment of the blood vessels is required. The process involves navigating the catheter through the vascular system to reach a specific area for diagnostic or therapeutic purposes, such as angiography or the delivery of medication. This code is crucial for accurate billing and documentation of the complexity and specificity of the procedure performed.
For CPT code 36247, which involves selective catheter placement in the abdominal or lower extremity artery at a third order or more selective level, 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 provider is billing for the interpretation of the procedure, not the technical component.
2. 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 may be necessary if multiple catheter placements are performed and need to be billed separately.
3. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the same procedure is repeated by the same physician on the same day. It helps in differentiating the repeated service from the initial one.
4. Modifier 77 - Repeat Procedure by Another Physician: This is used when the same procedure is repeated by a different physician on the same day. It ensures that the repeated service is recognized and reimbursed appropriately.
5. 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 there is an unplanned return to the procedure room for a related procedure during the postoperative period.
6. 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 it is unrelated to the original procedure.
7. Modifier XS - Separate Structure: This modifier is used to indicate that a service was performed on a separate organ/structure. It is part of the X{EPSU} subset of modifiers that provide greater specificity than modifier 59.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. It is important to use them appropriately to avoid claim denials or delays.
CPT code 36247 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies set by the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, the final decision on whether CPT code 36247 is reimbursed, and at what rate, can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) established by the MAC.
Therefore, it is essential for healthcare providers to verify the specific reimbursement details with their regional MAC to ensure compliance and accurate billing.
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