CPT code 37191 is used for procedures involving the insertion of an endovascular vena cava filter to prevent blood clots from reaching the lungs.
CPT code 37191 is used to describe the procedure of inserting an endovascular vena cava filter. This code is specifically utilized when a healthcare provider places a filter into the inferior vena cava, which is the large vein that carries deoxygenated blood from the lower body back to the heart. The purpose of this filter is to prevent blood clots from traveling to the lungs, which can cause a pulmonary embolism. This procedure is typically performed using minimally invasive techniques, often involving the use of imaging guidance to accurately position the filter within the vein.
For CPT code 37191, which involves the insertion of an endovascular vena cava filter, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the service provided involves only the professional component, such as the interpretation of the procedure, without the technical component.
2. Modifier TC - Technical Component: This is used when the service provided involves only the technical component, such as the use of equipment and supplies, without 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 may be necessary if multiple procedures are performed that are not typically reported together.
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.
5. Modifier 77 - Repeat Procedure by Another Physician: This is used when the same procedure is repeated by a different physician 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 related procedure is performed during the postoperative period of the initial procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial 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 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 is used when an assistant surgeon is required due to the unavailability of a qualified resident surgeon.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This is used when a non-physician provider assists in the surgery.
These modifiers help clarify the specifics of the service provided and ensure accurate billing and reimbursement. It is important to use them appropriately to avoid claim denials or delays.
CPT code 37191 is subject to reimbursement by 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 forth by the Medicare Administrative Contractor (MAC) in your region.
The MPFS provides a comprehensive list of services covered by Medicare and their respective reimbursement rates, which are updated annually. However, local coverage determinations (LCDs) made by MACs can influence whether a particular service is reimbursed in a specific geographic area.
Therefore, it is crucial for healthcare providers to verify the reimbursement status of CPT code 37191 by consulting the MPFS and the relevant MAC's policies to ensure compliance and accurate billing.
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