CPT code 37218 is used for the procedure involving the placement of a stent in the carotid artery to improve blood flow and prevent blockages.
CPT code 37218 is used to describe the procedure of placing a stent in the antegrade direction within the carotid artery. This procedure is typically performed to treat carotid artery stenosis, which is a narrowing of the carotid arteries that can lead to reduced blood flow to the brain and increase the risk of stroke. The stent acts as a scaffold to keep the artery open, ensuring adequate blood flow. This code is specific to the placement of the stent and may be used in conjunction with other codes that describe related procedures or diagnostic imaging performed during the same session.
When considering the use of modifiers for CPT code 37218, which pertains to stent placement in the ante carotid, it is important to understand the specific circumstances under which each modifier would be applicable. Here is a list of potential modifiers that could be used with this code, along with the reasons for their use:
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 stent placement is performed on both sides of the carotid arteries during the same session, this modifier indicates that the procedure was bilateral.
3. Modifier 51 - Multiple Procedures: This is used when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed and helps in the correct allocation of reimbursement.
4. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the discretion of the physician, this modifier indicates that the full service was not provided.
5. Modifier 59 - Distinct Procedural Service: This is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is used to indicate the shared responsibility.
7. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician on the same day, this modifier is used to indicate the repetition.
8. Modifier 77 - Repeat Procedure by Another Physician: This is used when the same procedure is repeated by a different physician on the same day.
9. 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 needs to return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This indicates that a procedure performed during the postoperative period was unrelated to the original procedure.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is necessary, and a qualified resident is not available.
Each of these modifiers serves a specific purpose and should be applied based on the clinical scenario and documentation available. Proper use of modifiers ensures accurate billing and reimbursement for the services provided.
CPT code 37218, which involves a specific medical procedure, is subject to reimbursement considerations under Medicare. To determine if this code is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the associated reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can offer guidance on whether a particular CPT code, such as 37218, is reimbursed in specific regions. They may also provide information on any local coverage determinations (LCDs) that could affect reimbursement.
Therefore, to ascertain if CPT code 37218 is reimbursed by Medicare, healthcare providers should review the MPFS and consult with their regional MAC for the most accurate and up-to-date information.
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 37218, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and maximize your financial outcomes.
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
