CPT code 37197 is used for the procedure of removing a foreign body from within a blood vessel, ensuring proper vascular function.
CPT code 37197 is used to describe the procedure of removing an intravascular foreign body. This code is applicable when a healthcare provider performs a procedure to extract an object that is lodged within the blood vessels. Such foreign bodies can include medical devices, fragments, or other materials that have inadvertently entered the vascular system. The removal is typically done using specialized tools and techniques to ensure the safety and integrity of the blood vessels while effectively extracting the foreign object. This procedure is crucial in preventing potential complications such as blockages or infections that could arise from the presence of foreign materials within the vascular system.
For CPT code 37197, which involves the removal of an intravascular foreign body, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed, typically when the procedure involves both a technical and professional component.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier indicates that the service was bilateral.
3. Modifier 51 - Multiple Procedures: This is used when multiple procedures are performed during the same session. It helps indicate that more than one procedure was conducted.
4. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier is used to indicate that the service was not performed in full.
5. Modifier 59 - Distinct Procedural Service: This modifier is applied when a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician, this modifier is used to indicate the repetition.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the procedure is repeated by a different physician.
8. 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 is used when the patient returns to the operating room for a related procedure during the postoperative period.
9. 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.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier indicates their involvement.
11. Modifier 81 - Minimum Assistant Surgeon: This is used when a minimum assistant surgeon is involved in the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 37197 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 37197 is reimbursed can vary based on the specific guidelines and coverage determinations set forth by the MAC in your region.
It is essential for healthcare providers to verify the reimbursement status of CPT code 37197 with their local MAC to ensure compliance and accurate billing.
Discover the power of MD Clarity's RevFind software to ensure you're receiving every dollar you're owed. With the ability to read your contracts and detect underpayments down to the CPT code level, including CPT code 37197, 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
