CPT CODES

CPT Code 36830

CPT code 36830 is used for procedures involving the creation of a connection between an artery and a vein using a nonautograft material.

Table of Contents
What is CPT Code 36830
Does CPT 36830 Need a Modifier?
CPT Code 36830 Medicare Reimbursement
Are You Being Underpaid for 36830 CPT Code?
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What is CPT Code 36830

CPT code 36830 is used to describe the surgical procedure of creating an arteriovenous (AV) fistula using a nonautograft material. This procedure involves connecting an artery to a vein using a synthetic or biologically derived graft, rather than using the patient's own tissue. It is typically performed to facilitate hemodialysis in patients with kidney failure, providing a reliable access point for the dialysis process. The use of nonautograft materials can be necessary when the patient's own vessels are not suitable for creating a fistula.

Does CPT 36830 Need a Modifier?

For CPT code 36830, which pertains to an artery-vein nonautograft procedure, the following modifiers may be applicable depending on the specific circumstances of the procedure:

1. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed on the same day.

2. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It is used when procedures are not normally reported together but are appropriate under the circumstances.

3. Modifier 62 (Two Surgeons): If two surgeons are required to perform the procedure due to its complexity, this modifier is used to indicate that each surgeon is performing a distinct part of the procedure.

4. Modifier 66 (Surgical Team): This modifier is used when a team of surgeons is necessary to perform the procedure due to its complexity.

5. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when the same physician repeats the procedure on the same day.

6. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a different physician repeats the procedure on the same day.

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 must return 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 it is unrelated to the original procedure.

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 guidelines and payer policies to determine the appropriate use of each modifier.

CPT Code 36830 Medicare Reimbursement

CPT code 36830 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. However, the actual reimbursement for CPT code 36830 can vary based on several factors, including geographic location and local coverage determinations.

Medicare Administrative Contractors (MACs) play a crucial role in this process. They are responsible for processing claims and making coverage decisions based on national and local policies. Each MAC may have specific guidelines or requirements that healthcare providers must meet to ensure reimbursement for CPT code 36830. Therefore, it is essential for providers to consult with their respective MACs to understand any local coverage determinations or additional documentation requirements that may affect reimbursement for this code.

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