CPT code 36831 is for a surgical procedure to remove a blood clot from an arteriovenous fistula, often used in dialysis patients.
CPT code 36831 is used to describe the surgical procedure of an open thrombectomy of an arteriovenous (AV) fistula. This procedure involves the removal of a thrombus, or blood clot, from an AV fistula, which is often used for hemodialysis access in patients with kidney failure. The goal of this procedure is to restore proper blood flow through the fistula, ensuring it functions effectively for dialysis treatment. This code is specifically utilized by healthcare providers to document and bill for the surgical intervention required to clear the blockage in the AV fistula.
For CPT code 36831, which pertains to an open thrombectomy of an arteriovenous (AV) fistula, 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. Documentation must support the substantial additional work and the reason for the additional work.
2. Modifier 50 (Bilateral Procedure): If the procedure is performed on both sides of the body, this modifier indicates that the procedure was bilateral.
3. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed.
4. Modifier 52 (Reduced Services): This is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. 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.
6. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when the same procedure is repeated by the same physician subsequent to the original procedure.
7. Modifier 77 (Repeat Procedure by Another Physician): This is used when the same procedure is repeated by a different physician.
8. 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 patient returns to the operating room for a related procedure during the postoperative period.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): This is used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used when an assistant surgeon is required, and a qualified resident surgeon is not available.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used when a non-physician practitioner assists in the surgery.
Each modifier has specific documentation requirements and should be used appropriately to ensure accurate billing and reimbursement.
CPT code 36831 is associated with the procedure of open thrombectomy of an arteriovenous (AV) fistula. Whether this code is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) in your region.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. CPT code 36831 is typically included in the MPFS, indicating that it is generally eligible for reimbursement under Medicare. However, the actual reimbursement can vary based on geographic location, as each MAC has the authority to interpret Medicare policies and determine coverage specifics within their jurisdiction.
To ensure accurate reimbursement, healthcare providers should verify the coverage and payment details for CPT code 36831 with their local MAC. This includes checking for any specific documentation requirements or prior authorization that may be necessary for the procedure to be covered. Additionally, providers should stay informed about any updates to the MPFS or MAC guidelines that could affect the reimbursement status of this code.
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