CPT code 37790 is used for procedures involving penile venous occlusion, aiding in the standardization and categorization of medical services.
CPT code 37790 is used to describe a medical procedure known as penile venous occlusion. This procedure is typically performed to address issues related to erectile dysfunction that are caused by venous leakage. During the procedure, a surgeon will occlude or block certain veins in the penis to prevent blood from flowing out too quickly, thereby helping to maintain an erection. This code is used by healthcare providers to document and bill for this specific surgical intervention.
For CPT code 37790, which pertains to penile venous occlusion, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to complications or unexpected circumstances during the procedure.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier indicates that it was a bilateral procedure.
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 performed.
4. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. 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.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician, this modifier is used to indicate the repetition.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated 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 when a patient returns 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: This modifier is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier indicates that a minimum assistant surgeon was required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
These modifiers help provide additional information about the circumstances under which the procedure was performed, which can be crucial for accurate billing and reimbursement. Always ensure that the use of modifiers is supported by proper documentation in the patient's medical record.
CPT code 37790 is associated with a procedure that may not be routinely reimbursed by Medicare. To determine if this specific CPT code is reimbursed, it is essential to consult the Medicare Physician Fee Schedule (MPFS), which provides a comprehensive list of services covered by Medicare along with their respective reimbursement rates.
Additionally, reimbursement can vary based on the local coverage determinations made by the Medicare Administrative Contractor (MAC) in your region. Each MAC has the authority to interpret national policies and establish coverage guidelines for services within their jurisdiction.
Therefore, it is advisable to check with the relevant MAC for specific coverage details and any potential reimbursement for CPT code 37790.
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 37790, 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
