CPT code 37247 is used for reporting an additional artery procedure involving transluminal balloon angioplasty.
CPT code 37247 is used to describe the procedure of performing a transluminal balloon angioplasty on an additional artery. This code is typically used when a healthcare provider performs a balloon angioplasty, which is a minimally invasive procedure to open up narrowed or blocked blood vessels, on more than one artery during the same session. The code 37247 specifically accounts for the work done on each additional artery beyond the first one treated, ensuring that the billing accurately reflects the complexity and extent of the procedure.
For CPT code 37247, which involves transluminal balloon angioplasty of an additional artery, 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 angioplasty was conducted on bilateral arteries.
2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It helps in identifying that 37247 is one of several procedures conducted.
3. Modifier 59 - Distinct Procedural Service: This modifier is applied 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 typically considered inclusive.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same procedure is repeated by the same physician on the same day. It indicates that 37247 was performed more than once.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the procedure is repeated by a different physician on the same day. It signifies that 37247 was performed again by another provider.
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 if the 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 the procedure is unrelated to the original procedure and occurs during the postoperative period.
8. Modifier XS - Separate Structure: This modifier is used to indicate that the procedure was performed on a separate organ/structure, which is significant in distinguishing it from other procedures performed on the same day.
These modifiers help in accurately coding and billing for the procedure, ensuring that the nuances of the service provided are captured and reimbursed appropriately.
CPT code 37247 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 comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, the final decision on whether a particular CPT code like 37247 is reimbursed can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) established by the MACs.
Therefore, it is crucial for healthcare providers to consult the relevant MAC guidelines and the MPFS to confirm the reimbursement status and any specific billing requirements for CPT code 37247.
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