CPT code 37184 is used for reporting the primary mechanical thrombectomy procedure on the first vessel in medical documentation.
CPT code 37184 is used to describe the primary mechanical thrombectomy procedure for the first vessel. This code is applicable when a healthcare provider performs a mechanical thrombectomy, which is a minimally invasive procedure aimed at removing a blood clot from a blood vessel. The procedure is typically performed to restore blood flow in cases where a clot is obstructing circulation, often in the context of acute ischemic stroke or other vascular conditions. The "first vessel" designation indicates that this code is used for the initial vessel treated during the procedure. If additional vessels require treatment, separate codes may be used to account for those interventions.
For CPT code 37184, which involves primary mechanical thrombectomy of the first vessel, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the service provided is the professional component, such as the interpretation of the procedure, separate from the technical component.
2. Modifier TC - Technical Component: This modifier is used when the service provided is the technical component, such as the use of equipment and supplies, separate from the professional component.
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 often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
4. 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 on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by a different provider on the same day.
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.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure performed during the postoperative period is unrelated to the original procedure.
8. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
9. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required for a minimal portion of the procedure.
10. 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.
11. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided.
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 change over time.
CPT code 37184 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource for determining if and how much Medicare will reimburse for a specific CPT code. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make determinations on coverage and payment for specific services within their jurisdiction. They may have local coverage determinations (LCDs) that affect whether CPT code 37184 is reimbursed.
To ascertain if CPT code 37184 is reimbursed by Medicare, healthcare providers should consult the MPFS for the specific payment rate and check with their regional MAC for any local coverage policies that might impact reimbursement. It is also advisable to verify any updates or changes in reimbursement policies, as these can vary annually or based on new regulations.
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