CPT code 36833 is used for procedures involving the revision of an arteriovenous fistula, often performed to improve blood flow for dialysis.
CPT code 36833 is used to describe the surgical procedure for the revision of an arteriovenous (AV) fistula. An AV fistula is a connection made between an artery and a vein, typically in the arm, to facilitate hemodialysis for patients with kidney failure. Over time, these fistulas can develop complications such as stenosis (narrowing), thrombosis (clotting), or other structural issues that impede their function. The revision procedure involves surgically correcting these problems to restore or improve the fistula's performance, ensuring that it continues to provide adequate blood flow for dialysis treatments. This code is crucial for healthcare providers to accurately document and bill for the specific surgical intervention performed on the AV fistula.
For CPT code 36833, which pertains to the revision 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. This could be due to complications or additional work involved in the revision of the AV fistula.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier should be used to indicate that the revision 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 carried out.
4. Modifier 52 - Reduced Services: This modifier is applicable if the procedure was partially reduced or eliminated at the discretion of the physician.
5. Modifier 59 - Distinct Procedural Service: This is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is particularly useful when procedures are not typically reported together but are appropriate under the circumstances.
6. Modifier 76 - Repeat Procedure or Service by Same Physician: If the same procedure is repeated by the same physician, this modifier is used to indicate the repetition.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the 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 is used when the 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: If the procedure is unrelated to the original surgery and occurs during the postoperative period, this modifier is applicable.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be used.
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 necessary due to the unavailability of a qualified resident surgeon.
13. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the service, this modifier is used to indicate that multiple modifiers apply.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies to ensure accurate billing and reimbursement.
CPT code 36833 is subject to reimbursement by Medicare, but whether it is reimbursed 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 provides a comprehensive list of services covered by Medicare, along with the payment rates for each service. However, the final determination of reimbursement can vary based on local coverage determinations (LCDs) and other policies established by the MAC responsible for your area.
Therefore, it is crucial for healthcare providers to verify the specific coverage and reimbursement details for CPT code 36833 with their respective MAC to ensure compliance and proper billing practices.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including CPT code 36833. Schedule a demo today to see how RevFind can pinpoint discrepancies by individual payer, ensuring you receive the full reimbursement you deserve.
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