CPT code 36248 is used for procedures involving the insertion of a catheter into additional abdominal or lower extremity arteries.
CPT code 36248 is used to describe the procedure of inserting a catheter into an additional abdominal or lower extremity artery. This code is typically used in the context of angiography or other diagnostic imaging procedures where a catheter is navigated through the vascular system to reach a specific artery for further examination or intervention. The term "addl" indicates that this code is used for each additional artery accessed beyond the initial one, which would be coded separately. This allows healthcare providers to accurately document and bill for the complexity and extent of the procedure performed.
For CPT code 36248, which involves additional selective catheterization of the abdominal or lower extremity arteries, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the service provided is the professional component only, such as the interpretation of the procedure, separate from 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 is often used to bypass National Correct Coding Initiative (NCCI) edits when procedures are typically bundled together.
3. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same provider on the same day.
4. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by a different provider on the same day.
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 when a related procedure is performed during the postoperative period of the initial procedure.
6. 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 provider during the postoperative period of the initial procedure.
7. Modifier XS - Separate Structure: This modifier is used to indicate that a service was performed on a separate organ/structure.
These modifiers help clarify the circumstances under which the procedure was performed and ensure accurate billing and reimbursement. It is essential to use them appropriately to avoid claim denials and ensure compliance with payer policies.
CPT code 36248 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 forth 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 actual reimbursement for CPT code 36248 can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) established by the MACs.
These contractors are responsible for processing Medicare claims and can influence whether a particular service is covered and the extent of reimbursement. Therefore, it is crucial for healthcare providers to verify the specific guidelines and reimbursement rates applicable to CPT code 36248 with their regional MAC to ensure compliance and accurate billing.
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