CPT code 37211 is used for documenting thrombolytic therapy in arteries, helping healthcare providers standardize and streamline procedure reporting.
CPT code 37211 is used to describe a medical procedure known as thrombolytic arterial therapy. This procedure involves the administration of medication directly into an artery to dissolve blood clots. It is typically performed to restore normal blood flow in cases where clots have caused blockages, which can lead to serious conditions such as strokes or heart attacks. The therapy is often guided by imaging techniques to ensure precise delivery of the thrombolytic agent, enhancing the effectiveness of the treatment and minimizing potential complications.
For CPT code 37211, which pertains to thrombolytic arterial therapy, 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 is applicable if the physician is providing only the interpretation of the procedure.
2. Modifier TC - Technical Component: This is used when only the technical component of the service is being billed. It applies if the facility is billing for the use of equipment and supplies without the professional interpretation.
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 and need to be reported separately.
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. It indicates that the repeat procedure was necessary.
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. It helps in distinguishing the services provided by different practitioners.
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 if the patient needs to return 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 is used when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
8. Modifier XS - Separate Structure: This modifier is used to indicate that a service was performed on a separate organ/structure. It is part of the X{EPSU} subset of modifiers that provide more specific information than modifier 59.
9. Modifier XE - Separate Encounter: This is used to indicate that a service was performed during a separate encounter on the same day.
10. Modifier XP - Separate Practitioner: This modifier is used when a service is performed by a different practitioner.
11. Modifier XU - Unusual Non-Overlapping Service: This is used to indicate that a service does not overlap usual components of the main service.
These modifiers help in accurately reporting the circumstances under which the thrombolytic arterial therapy was performed, ensuring appropriate billing and reimbursement. Always consult the latest coding guidelines and payer-specific policies to determine the correct use of modifiers.
CPT code 37211 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the payment rates for each service. However, the actual reimbursement for CPT code 37211 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting local coverage determinations, which can influence whether and how much Medicare reimburses for this particular code. Therefore, healthcare providers should consult their specific MAC for detailed information on reimbursement rates and any additional requirements for CPT code 37211.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 37211, 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
