CPT code 37238 is used for procedures involving the placement of a stent in a vessel through open or percutaneous methods.
CPT code 37238 is used to describe the procedure of placing a stent in a blood vessel through an open or percutaneous (through the skin) approach. This code is specifically applied when the stent placement is performed in a vessel that has already been treated with another procedure, such as angioplasty, during the same session. The purpose of the stent is to keep the vessel open and ensure proper blood flow, which is crucial in treating conditions like blockages or narrowing of the arteries. This code is often used in interventional radiology or vascular surgery settings.
For CPT code 37238, which involves the placement of a stent, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:
1. Modifier 26 - Professional Component: This modifier is used when the professional component of the service is being billed separately from the technical component.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed bilaterally, this modifier indicates that the service was performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: This is used when multiple procedures are performed during the same session. It helps indicate that more than one procedure was carried out.
4. Modifier 52 - Reduced Services: This modifier is applicable if the procedure was partially reduced or eliminated at the physician's discretion.
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.
6. Modifier 62 - Two Surgeons: If two surgeons are required for the procedure, this modifier indicates that both surgeons are performing distinct parts of the procedure.
7. Modifier 76 - Repeat Procedure by Same Physician: This is used when the same physician repeats the procedure on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated by a different physician on the same day.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This is used when a patient returns 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: This is used when an assistant surgeon is required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: This indicates that a minimum assistant surgeon was necessary for the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is required due to the unavailability of a qualified resident surgeon.
14. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although less common for this type of procedure, this modifier is used when a laboratory test is repeated for clinical reasons.
The selection of modifiers should be based on the specific details of the procedure and the circumstances under which it was performed. Proper use of modifiers ensures accurate billing and reimbursement.
CPT code 37238 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 your specific region.
The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates. However, the final decision on reimbursement can vary based on local coverage determinations (LCDs) made by the MAC, which may impose specific guidelines or requirements for the use of CPT code 37238.
Therefore, healthcare providers should consult the MPFS and their regional MAC to confirm the reimbursement status and any applicable conditions for this code.
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