CPT code 37222 is used for an additional procedure to improve blood flow in the iliac artery, often part of vascular interventions.
CPT code 37222 is an add-on code used to describe the revascularization of the iliac artery through an endovascular approach, specifically for each additional vessel treated beyond the initial one. This code is typically used in conjunction with a primary code that describes the first vessel treated. It involves procedures such as angioplasty, stenting, or atherectomy to restore blood flow in the iliac arteries, which are major blood vessels in the pelvis that supply blood to the legs. This code is crucial for accurately billing and documenting the additional work performed during a revascularization procedure.
For CPT code 37222, which pertains to iliac revascularization as an add-on procedure, the following modifiers may be applicable:
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 only providing the interpretation of the procedure.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier is used to indicate that the service was performed bilaterally.
3. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same session. It indicates that the procedure is one of several performed.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It is used to prevent bundling of services that are not typically reported together.
5. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician, this modifier is used to indicate that the procedure was repeated.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the procedure is repeated by a different physician, indicating that the same service was performed again.
7. 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 is used when the patient returns to the operating room for a related procedure during the postoperative period.
8. 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.
9. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is necessary, and 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 37222, which is an add-on code, is typically reimbursed by Medicare, provided that it meets the necessary criteria outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered.
However, it is important to note that reimbursement can vary based on the specific Medicare Administrative Contractor (MAC) that processes claims in your region. Each MAC may have slightly different policies and guidelines, so it is crucial to verify with your local MAC to ensure that CPT code 37222 is covered and to understand any specific documentation or billing requirements that may apply.
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 37222, RevFind provides unparalleled accuracy and insight 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
