CPT code 36252 is used for a procedure involving the insertion of a catheter into the first bilateral renal artery for diagnostic or therapeutic purposes.
CPT code 36252 is used to describe the procedure of inserting a catheter into the renal arteries for diagnostic purposes, specifically when the procedure is performed bilaterally, meaning on both sides. This code is typically used in the context of angiography, where a contrast dye is injected through the catheter to visualize the renal arteries using imaging techniques. This helps in assessing conditions such as renal artery stenosis or other vascular abnormalities affecting the kidneys. The "1st bilat" indicates that this is the initial catheterization of both renal arteries during the procedure.
For CPT code 36252, which involves catheterization of the renal artery, first order, bilateral, 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 50 - Bilateral Procedure: Although the code description already indicates a bilateral procedure, some payers may still require this modifier to ensure proper billing and reimbursement.
3. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same session, this modifier may be used to indicate that multiple services were provided.
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.
5. Modifier 76 - Repeat Procedure by Same Physician: If the procedure needs to be repeated by the same physician, this modifier is used to indicate the repeat nature of the service.
6. Modifier 77 - Repeat Procedure by Another Physician: Similar to Modifier 76, but used when the repeat procedure is performed by a different physician.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: If there is an unplanned return to the operating room for a related procedure during the postoperative period, this modifier is applicable.
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.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement. Always verify with specific payer guidelines, as requirements for modifiers can vary.
CPT code 36252 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of services covered by Medicare, including their associated reimbursement rates. To determine if CPT code 36252 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the specific payment rate applicable.
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 local coverage determinations (LCDs) that may affect the reimbursement of CPT code 36252. These contractors may have specific policies or requirements that influence whether and how the code is reimbursed in different regions.
Therefore, while CPT code 36252 can be reimbursed by Medicare, providers should verify its status on the MPFS and consult their respective MAC for any regional variations or additional documentation requirements that might impact reimbursement.
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