CPT code 37220 is used for procedures involving the revascularization of the iliac artery to improve blood flow.
CPT code 37220 is used to describe the revascularization of an iliac artery through an endovascular approach, specifically involving a transluminal angioplasty. This procedure is typically performed to restore adequate blood flow in the iliac arteries, which are major blood vessels in the pelvis that supply blood to the lower limbs. The code indicates that the procedure was conducted without the use of stents or other devices, focusing solely on the angioplasty technique to widen the narrowed or blocked artery. This code is crucial for accurate billing and documentation in healthcare settings, ensuring that the specific nature of the procedure is clearly communicated for reimbursement and record-keeping purposes.
For CPT code 37220, which pertains to iliac revascularization, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: This modifier is used when the procedure is performed on both sides of the body. If iliac revascularization is performed bilaterally, this modifier should be appended to indicate that the procedure was done on both iliac arteries.
2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. If iliac revascularization is performed along with other procedures, Modifier 51 may be necessary to indicate that multiple procedures were conducted.
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. If iliac revascularization is performed as a separate and distinct service from other procedures, Modifier 59 can be used to clarify this distinction.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician. If iliac revascularization needs to be repeated during the same session or on the same day, Modifier 76 should be used.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician. If iliac revascularization is repeated by another physician, Modifier 77 should be appended.
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 the patient returns to the operating room for a related procedure during the postoperative period. If a related iliac revascularization procedure is necessary, Modifier 78 may be applicable.
7. 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. If iliac revascularization is performed as an unrelated procedure, Modifier 79 should be used.
These modifiers help provide additional information about the circumstances under which the iliac revascularization procedure was performed, ensuring accurate billing and reimbursement.
CPT code 37220 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies set forth by the Medicare Administrative Contractor (MAC) in your specific region. The MPFS provides a list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered, and it is updated annually to reflect changes in practice costs and other economic factors.
To determine if CPT code 37220 is reimbursed, you would need to consult the MPFS to see if the code is listed and what the associated reimbursement rate is. Additionally, MACs, which are private health insurers contracted by Medicare to process claims, may have specific local coverage determinations (LCDs) that affect whether and how a particular service is reimbursed. These LCDs can vary by region, so it's important to check with the MAC that services your area to understand any specific coverage criteria or documentation requirements that might apply to CPT code 37220.
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