CPT code 37182 is used for the procedure of inserting a hepatic shunt, specifically a transjugular intrahepatic portosystemic shunt (TIPS).
CPT code 37182 is used to describe the procedure of inserting a transjugular intrahepatic portosystemic shunt (TIPS). This is a minimally invasive procedure performed by an interventional radiologist to create a pathway within the liver that connects the portal vein to the hepatic vein. The purpose of this shunt is to reduce portal hypertension, which is high blood pressure in the portal vein system, often caused by liver cirrhosis. By inserting this shunt, blood flow is redirected, helping to alleviate complications such as variceal bleeding and ascites associated with portal hypertension.
For the CPT code 37182, which involves the insertion of a hepatic shunt (TIPS), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 26 - Professional Component: This modifier is used when the professional component of the service is being billed separately from the technical component. It indicates that the billing is for the physician's interpretation and report.
2. Modifier 52 - Reduced Services: This modifier is applicable if the procedure was partially reduced or eliminated at the physician's discretion. It indicates that the service provided was less than usually required.
3. 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 to avoid bundling issues when multiple procedures are performed.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day. It indicates that the procedure was necessary to be repeated.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day. It indicates that the procedure was necessary to be repeated by another provider.
6. 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 of the initial procedure.
7. 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.
8. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure. It indicates that another surgeon assisted in the procedure.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
10. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided. It indicates that multiple modifiers are being used for the procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 37182, which involves the insertion of a hepatic shunt (TIPS), is generally reimbursed by Medicare, provided it meets the necessary coverage criteria and is deemed medically necessary. The reimbursement for this procedure is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services rendered by physicians and other healthcare professionals.
However, it's important to note that the reimbursement can vary based on geographic location and specific local coverage determinations made by the Medicare Administrative Contractor (MAC) responsible for the region. Each MAC has the authority to establish local policies and guidelines that may affect the reimbursement process. Therefore, healthcare providers should verify the specific coverage details and reimbursement rates with their respective MAC to ensure compliance and accurate billing.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 37182, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and enhance your revenue cycle management.
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
