CPT code 37616 is used for the procedure involving the tying off of a chest artery to prevent or stop bleeding.
CPT code 37616 is used to describe the surgical procedure involving the ligation, or tying off, of a chest artery. This procedure is typically performed to control bleeding or to manage certain vascular conditions within the thoracic region. By ligating the artery, the surgeon effectively stops blood flow through that vessel, which can be crucial in preventing hemorrhage or in treating aneurysms or other vascular abnormalities in the chest area.
For CPT code 37616, "Ligation of chest artery," 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 work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 - Bilateral Procedure: If the ligation of chest arteries is performed bilaterally, this modifier should be used to indicate that the procedure was performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed.
4. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is particularly relevant if the ligation is performed in conjunction with other procedures that are not typically performed together.
5. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier should be used to indicate the involvement of both surgeons.
6. Modifier 66 - Surgical Team: When a surgical team is necessary to perform the procedure, this modifier is used to indicate the involvement of multiple professionals working together.
7. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the ligation procedure on the same day, this modifier should be used.
8. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if a different physician repeats the ligation procedure on the same day.
9. 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.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Apply this modifier if the ligation is performed during the postoperative period of another procedure, but is unrelated to the initial surgery.
11. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required to help with the procedure, this modifier should be used.
12. Modifier 81 - Minimum Assistant Surgeon: Use this modifier when an assistant surgeon is required for a minimal portion of the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident is not available.
14. Modifier 99 - Multiple Modifiers: If more than four modifiers are necessary to describe the procedure, this modifier indicates that multiple modifiers are being used.
Each modifier should be used in accordance with the specific circumstances of the procedure and the payer's guidelines. Proper documentation is essential to support the use of any modifier.
CPT code 37616, which involves the ligation of a chest artery, 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 the reimbursement rates for services covered under Medicare Part B. To ascertain if CPT code 37616 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the specific payment rate applicable.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide guidance on whether CPT code 37616 is covered in specific regions, as coverage can vary based on local policies and medical necessity criteria. Providers should check with their respective MAC to ensure compliance with any local coverage determinations (LCDs) that might affect the reimbursement of this particular CPT 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 37616, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and optimize your financial outcomes.
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
