CPT code 36818 is for creating an arteriovenous fistula in the upper arm using the cephalic vein, often used for dialysis access.
CPT code 36818 is used to describe the surgical creation of an arteriovenous (AV) fistula in the upper arm, specifically involving the cephalic vein. This procedure is typically performed to facilitate hemodialysis in patients with chronic kidney disease. By connecting an artery to a vein, the blood flow is increased, which helps in the efficient removal and return of blood during dialysis sessions. The cephalic vein is a common choice for this procedure due to its accessibility and size, making it suitable for repeated needle insertions required during dialysis treatments.
For CPT code 36818, which involves the creation of an arteriovenous (AV) fistula in the upper arm using the cephalic vein, 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 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to complications or additional work that was not anticipated.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both arms during the same surgical session, this modifier indicates that the procedure was bilateral.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was performed.
4. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: If the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient, this modifier is applicable.
6. 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.
7. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are involved.
8. Modifier 66 - Surgical Team: When a team of surgeons is required to perform the procedure, this modifier is used to indicate the involvement of a surgical team.
9. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician, this modifier is used to indicate the repetition.
10. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier is used to indicate the repetition by another provider.
11. 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 needs to return to the operating room for a related procedure during the postoperative period.
12. 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 physician during the postoperative period.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review the specific details of each case to determine which modifiers are appropriate.
CPT code 36818 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 for understanding how Medicare reimburses specific CPT codes, including 36818. The MPFS provides a comprehensive list of services covered by Medicare and the associated payment rates, which are updated annually.
However, it's important to note that the reimbursement for CPT code 36818 can also be influenced by the local policies of Medicare Administrative Contractors (MACs). MACs are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that may affect whether a particular service is reimbursed in their jurisdiction. Therefore, while CPT code 36818 is generally reimbursable under Medicare, healthcare providers should consult both the MPFS and their specific MAC's guidelines to confirm coverage and payment details for their region.
Discover the power of MD Clarity's RevFind software to ensure you're receiving accurate payments. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 36818, RevFind provides unparalleled insights by individual payer. Schedule a demo today to see how RevFind can optimize your revenue cycle and safeguard your practice's financial health.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
