CPT code 36837 is for a procedure involving the creation of an arteriovenous fistula in the upper extremity through a separate access.
CPT code 36837 is used to describe a procedure involving the percutaneous (through the skin) creation of an arteriovenous fistula in the upper extremity using a catheter, performed through a separate access site. An arteriovenous fistula is a connection made between an artery and a vein, typically for the purpose of hemodialysis access. This code specifically refers to the creation of the fistula using a minimally invasive technique, which involves accessing the blood vessels through the skin rather than through open surgery.
For CPT code 36837, which involves procedures related to arteriovenous fistulas, 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 particularly useful when procedures are not typically reported together but are appropriate under the circumstances.
3. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when the same procedure is repeated by the same physician. It indicates that the procedure was necessary to be performed more than once.
4. Modifier 77 (Repeat Procedure by Another Physician): Similar to Modifier 76, this is used when the procedure is repeated but by a different physician.
5. Modifier 78 (Unplanned Return to the Operating/Procedure Room): This modifier is used when a patient returns to the operating room for a related procedure during the postoperative period of the initial procedure.
6. 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.
7. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required during the procedure.
8. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This is used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
9. Modifier LT (Left Side): This modifier is used to specify that the procedure was performed on the left side of the body.
10. Modifier RT (Right Side): This modifier is used to specify that the procedure was performed on the right side of the body.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to use them appropriately to avoid claim denials or delays.
The CPT code 36837 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, along with the payment rates for each service. However, the reimbursement for CPT code 36837 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for interpreting national Medicare policies and setting local coverage determinations, which can affect whether and how much a particular service is reimbursed. Therefore, healthcare providers should consult their local MAC for precise information regarding the reimbursement of CPT code 36837.
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