CPT code 37215 is used for a procedure involving the placement of a stent in the carotid artery using a catheter and embolic protection.
CPT code 37215 is used to describe a medical procedure involving the placement of a stent in the carotid artery via a catheter. This procedure is performed to treat carotid artery stenosis, which is a narrowing of the carotid artery that can lead to reduced blood flow to the brain and increase the risk of stroke. The "w/eps" in the description indicates that this procedure includes embolic protection, a technique used to capture and remove debris that may dislodge during the stenting process, thereby reducing the risk of embolism and stroke. This code is essential for healthcare providers to accurately document and bill for this specific endovascular intervention.
For CPT code 37215, which involves the transcath stent placement in the carotid artery with embolic protection, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the service provided is the professional component, such as the interpretation of the procedure, rather than the technical component.
2. Modifier TC - Technical Component: This modifier is used when the service provided is the technical component, such as the use of equipment and supplies, rather than 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 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 requires a 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 modifier is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
8. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required during the procedure.
9. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required during the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 37215 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in determining the reimbursement rates for this code. The MPFS outlines the payment amounts for services provided by physicians and other healthcare professionals, including those associated with CPT code 37215.
Additionally, Medicare Administrative Contractors (MACs) are responsible for processing claims and ensuring that services billed under CPT code 37215 meet Medicare's coverage criteria. MACs may have local coverage determinations (LCDs) that provide further guidance on the circumstances under which this code is reimbursable. Therefore, healthcare providers should consult the MPFS and their respective MAC's policies to ensure compliance and proper reimbursement for CPT code 37215.
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