CPT code 37185 is used for a primary arterial mechanical thrombectomy in a subsequent vessel, aiding in accurate procedure documentation.
CPT code 37185 is used to describe a procedure involving the primary mechanical thrombectomy of a subsequent vessel. This code is typically applied when a healthcare provider performs a mechanical thrombectomy, which is a minimally invasive procedure to remove a blood clot from a blood vessel, in a vessel that is not the initial target of treatment. This might occur when multiple vessels are affected, and the provider needs to address additional vessels beyond the primary one initially treated. The use of this code helps ensure accurate billing and documentation for the additional work performed during the procedure.
For CPT code 37185, which pertains to primary arterial mechanical thrombectomy in subsequent vessels, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body. It indicates that the procedure was performed bilaterally during the same session.
2. Modifier 51 - Multiple Procedures: This modifier is applicable when multiple procedures are performed during the same surgical session. It helps in indicating that more than one procedure was carried out.
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 particularly useful when procedures 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. It indicates that the procedure was necessary to be repeated.
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. It indicates that the procedure was necessary to be repeated by another healthcare professional.
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 an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
These modifiers help in accurately reporting the circumstances under which the procedure was performed, ensuring appropriate reimbursement and reducing the risk of claim denials. Always verify with the latest coding guidelines and payer-specific requirements as they can vary.
CPT code 37185 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the local Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare and assigns relative value units (RVUs) to each service, which are used to calculate reimbursement rates.
However, the final decision on whether CPT code 37185 is reimbursed can vary based on the specific MAC's local coverage determinations (LCDs) and any additional guidelines they may have in place.
Therefore, healthcare providers should consult the MPFS and their respective MAC to confirm the reimbursement status and any specific billing requirements for CPT code 37185.
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