CPT code 36836 is for a procedure involving the creation of an arteriovenous fistula in the upper extremity using one accessory vein.
CPT code 36836 is used to describe a procedure involving the percutaneous (through the skin) creation of an arteriovenous fistula in the upper extremity, specifically for one access site. An arteriovenous fistula is a connection made between an artery and a vein, typically used for hemodialysis access in patients with kidney failure. This code indicates that the procedure is performed without open surgery, using minimally invasive techniques to establish the fistula.
For CPT code 36836, which involves procedures related to arteriovenous fistula creation or revision, the following modifiers may be applicable:
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 a procedure or service was 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 distinct parts of the procedure, this modifier indicates that both surgeons are involved and each is performing a specific portion of the surgery.
4. Modifier 66 (Surgical Team): This modifier is used when a complex procedure requires a surgical team, indicating that multiple practitioners are involved in the surgery.
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 procedure is repeated by a different physician 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 a patient requires a 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 payer guidelines as they may have unique requirements for modifier usage.
The CPT code 36836 is reimbursed by Medicare, but its 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 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and providing guidance on coverage and reimbursement policies within their jurisdiction. Therefore, healthcare providers should consult their local MAC for detailed information on the reimbursement specifics for CPT code 36836.
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