CPT code 37234 is used for procedures involving the opening or repairing of a tibial or peroneal artery with a stent.
CPT code 37234 is used to describe a specific medical procedure involving the placement of a stent in the tibial or peroneal artery. This procedure is typically performed to open up narrowed or blocked arteries in the lower leg, which can improve blood flow and alleviate symptoms associated with peripheral artery disease (PAD). The code is part of the interventional radiology and endovascular surgery category, indicating that it involves minimally invasive techniques often guided by imaging technologies. This procedure is crucial for restoring circulation and preventing complications such as ulcers or gangrene in patients with compromised blood flow to the lower extremities.
For CPT code 37234, which involves the revascularization of the tibial/peroneal artery with an open or percutaneous approach using a stent, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body. It indicates that the same procedure was carried out on a mirror-image anatomical site.
2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It helps in identifying that more than one procedure was 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. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
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 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 the two are unrelated.
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 in providing additional information about the procedure, ensuring accurate billing and reimbursement. It is important to use them appropriately to avoid claim denials and ensure compliance with payer policies.
CPT code 37234 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies set by the Medicare Administrative Contractor (MAC) for the specific region.
The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, the final decision on whether CPT code 37234 is reimbursed can vary based on local coverage determinations (LCDs) made by the MACs, which are responsible for interpreting national policies and setting regional guidelines.
Therefore, healthcare providers should consult the MPFS and their respective MAC to confirm the reimbursement status of CPT code 37234.
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