CPT code 37145 is used for procedures involving the revision of blood circulation pathways to improve or restore proper blood flow.
CPT code 37145 is used to describe a surgical procedure that involves the revision of circulation. This typically refers to the surgical correction or modification of blood flow within the vascular system. The procedure may be necessary due to complications such as blockages, narrowing, or other issues affecting the proper circulation of blood. By revising the circulation, the healthcare provider aims to restore or improve blood flow to the affected area, thereby enhancing the patient's overall vascular health and function. This code is crucial for accurate billing and documentation of the specific surgical intervention performed.
For CPT code 37145, which involves the revision of circulation, the following modifiers may be applicable depending on the specific circumstances of the procedure and the payer requirements:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. 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.
3. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion. Documentation should support the reason for the reduction.
4. Modifier 59 - Distinct Procedural Service: Use this modifier 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.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same provider.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Use this when the procedure is repeated by a different provider.
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 related procedure is performed during the postoperative period of the initial procedure.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure is performed by the same provider during the postoperative period.
9. Modifier 80 - Assistant Surgeon: Use this modifier when an assistant surgeon is required for the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon provides minimal assistance during the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this when an assistant surgeon is necessary due to the unavailability of a qualified resident.
12. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided.
Each modifier serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper documentation is crucial to justify the use of any modifier.
The CPT code 37145 is subject to reimbursement considerations under 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 by the Medicare Administrative Contractor (MAC) for the region where the service is provided.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. If CPT code 37145 is listed in the MPFS, it indicates that Medicare has established a payment rate for this service, subject to any applicable conditions or limitations.
However, the final determination of reimbursement is also influenced by the local MAC, which administers Medicare claims and sets specific coverage policies and guidelines. Each MAC may have different interpretations or additional requirements for the reimbursement of CPT code 37145, such as medical necessity criteria or documentation requirements.
Therefore, healthcare providers should verify the reimbursement status of CPT code 37145 by consulting the MPFS and the relevant MAC's policies to ensure compliance and proper billing practices.
Discover how MD Clarity's RevFind software can enhance your revenue cycle by accurately reading your contracts and detecting underpayments down to the CPT code level, including CPT code 37145, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
