CPT code 37565 is used for the procedure involving the tying off of a neck vein to prevent blood flow, often for medical or surgical reasons.
CPT code 37565 is used to describe the surgical procedure involving the ligation of a neck vein. This procedure typically involves tying off a vein in the neck to prevent blood flow through it, which may be necessary for various medical reasons, such as treating certain vascular conditions or preventing complications from venous disorders. The code is utilized by healthcare providers to accurately document and bill for this specific surgical service within the healthcare revenue cycle.
For CPT code 37565, "Ligation of neck vein," the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly greater effort than typically required. This could be due to unusual anatomy or complications during the surgery.
2. Modifier 50 - Bilateral Procedure: If the ligation of neck veins is performed bilaterally, this modifier should be used to indicate that the procedure was done on both sides.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was carried out.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the ligation of the neck vein was a distinct service from other procedures performed on the same day. It is used to prevent bundling of services that are typically considered inclusive.
5. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons were necessary and each performed a distinct part of the procedure.
6. Modifier 76 - Repeat Procedure by Same Physician: If the procedure needs to be repeated by the same physician, this modifier is used to indicate that the repeat procedure was necessary.
7. Modifier 77 - Repeat Procedure by Another Physician: Similar to Modifier 76, but used when the repeat procedure is performed by a different physician.
8. 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 needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If an unrelated procedure is performed during the postoperative period of the initial surgery, this modifier is used to indicate that the procedures are not related.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required to help with the procedure, this modifier is used to indicate their involvement.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary because a qualified resident is not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician practitioner assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always consult the latest coding guidelines and payer-specific policies to determine the appropriate use of modifiers.
CPT code 37565, which pertains to the ligation of a neck vein, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines whether a specific CPT code is reimbursable and at what rate. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals under Medicare Part B.
To ascertain if CPT code 37565 is reimbursed, healthcare providers should consult the MPFS to verify its inclusion and the associated reimbursement rate. Additionally, Medicare Administrative Contractors (MACs) play a pivotal role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make determinations regarding coverage and payment for specific services within their jurisdiction.
Providers should also be aware that coverage can vary based on local coverage determinations (LCDs) set by MACs, which may impose specific criteria or documentation requirements for reimbursement. Therefore, it is essential for healthcare providers to check both the MPFS and any relevant LCDs from their respective MAC to ensure compliance and eligibility for reimbursement of CPT code 37565.
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 37565, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize 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
