CPT code 37195 is used for procedures involving thrombolytic therapy to treat a stroke, detailing the specific medical service provided.
CPT code 37195 is used to describe a medical procedure involving thrombolytic therapy for the treatment of a stroke. This code is specifically assigned to the administration of medication designed to dissolve blood clots that are obstructing blood flow to the brain, which is a common cause of strokes. The procedure aims to restore normal circulation and minimize potential damage to brain tissue. This code is crucial for healthcare providers to accurately document and bill for the specialized care provided during such critical interventions.
For CPT code 37195, which pertains to thrombolytic therapy for stroke, 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 TC - Technical Component: This modifier is used when the technical component of the service is being billed separately from the professional component. It indicates that the billing is for the use of equipment, supplies, and technical staff.
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 prevent bundling of services that are typically considered part of a comprehensive service.
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 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used when a laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
These modifiers help provide additional information about the service provided and ensure accurate billing and reimbursement. It is important to review the specific circumstances of each case to determine the appropriate modifier(s) to use.
CPT code 37195 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) in your region.
The MPFS outlines the payment rates for services covered by Medicare, and each MAC may have additional local coverage determinations that affect reimbursement.
Therefore, to determine if CPT code 37195 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and check with their regional MAC for any specific coverage policies or requirements.
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