CPT code 37205 is used for a procedure involving the placement of a stent in a blood vessel through a catheter inserted via the skin.
CPT code 37205 is used to describe the procedure of placing a stent in a blood vessel through a catheter that is inserted percutaneously, meaning through the skin. This code is specifically for the insertion of an intravascular stent, which is a small, mesh-like tube that helps keep blood vessels open and ensures proper blood flow. The procedure is typically performed by interventional radiologists or cardiologists and is often used to treat conditions such as narrowed or blocked arteries.
For CPT code 37205, which involves the procedure of transcath IV stent placement percutaneously, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the procedure involves both a professional and technical component, and the billing is only for the professional component, such as the physician's interpretation of the procedure.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier indicates that the procedure was performed bilaterally.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same session, this modifier is used to indicate that more than one procedure was conducted.
4. 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.
5. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure, this modifier indicates that each surgeon is performing a distinct part of the procedure.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same physician repeats the procedure on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a different physician repeats the procedure on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used when a patient must return 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 a procedure performed during the postoperative period is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
11. 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 of the procedure, ensuring accurate billing and reimbursement. It's important to use them appropriately to reflect the specifics of the service provided.
CPT code 37205 is associated with procedures that may be reimbursed by Medicare, but whether it is reimbursed depends on several factors, including the specifics of the procedure, the setting in which it is performed, and the local coverage determinations made by the Medicare Administrative Contractor (MAC) for your region.
To determine if CPT code 37205 is reimbursed by Medicare, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS), which provides information on the payment rates for services covered under Medicare Part B. Additionally, providers should review any relevant Local Coverage Determinations (LCDs) or National Coverage Determinations (NCDs) issued by the MAC, as these documents outline the conditions under which Medicare will cover specific procedures.
It is important for healthcare providers to verify the reimbursement status of CPT code 37205 with their specific MAC to ensure compliance with Medicare billing requirements and to understand any documentation or medical necessity criteria that must be met for reimbursement.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and pinpointing underpayments down to the CPT code level, including specific codes like 37205. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
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