CPT code 37225 is used for procedures involving revascularization of the femoral or popliteal artery to treat atherosclerosis.
CPT code 37225 is used to describe a specific medical procedure known as "femoral/popliteal revascularization with atherectomy." This procedure involves the removal of plaque or blockages from the femoral or popliteal arteries, which are major blood vessels in the leg. The goal of this procedure is to restore proper blood flow to the affected area, often to alleviate symptoms associated with peripheral artery disease (PAD) such as pain or cramping in the legs. Atherectomy is a minimally invasive technique that uses a catheter-based device to shave or cut away the plaque, improving circulation and reducing the risk of more serious complications like ulcers or gangrene.
For CPT code 37225, which involves femoral/popliteal revascularization with atherectomy, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both the left and right sides during the same session. It indicates that the procedure was performed bilaterally.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was performed.
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 is often used to bypass National Correct Coding Initiative (NCCI) edits.
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.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician 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 returns 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 LT - Left Side: This modifier is used to specify that the procedure was performed on the left side of the body.
9. Modifier RT - Right Side: This modifier is used to specify that the procedure was performed on the right side of the body.
These modifiers help provide additional information about the procedure performed and ensure accurate billing and reimbursement. It is important to use them appropriately to avoid claim denials or delays.
CPT code 37225 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 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national Medicare policies and establish local coverage determinations, which can influence whether and how a particular service, such as that represented by CPT code 37225, is reimbursed. Therefore, healthcare providers should consult their specific MAC for detailed information on reimbursement rates and coverage criteria for this code.
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 37225, 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
