CPT code 70390 is for an X-ray exam of the salivary duct, used to diagnose issues like blockages or stones in the salivary glands.
CPT code 70390 is used to describe an X-ray examination of the salivary duct. This procedure involves taking X-ray images to assess the salivary ducts, which are the channels that carry saliva from the salivary glands to the mouth. This type of exam is typically performed to diagnose blockages, stones, or other abnormalities within the salivary ducts that may be causing symptoms such as swelling or pain.
When considering the use of modifiers for the CPT codes 70380 and 70390, it's important to understand the context in which these procedures are performed. Modifiers are used to provide additional information about the performed procedure and can affect reimbursement. Here is a list of potential modifiers that could be applicable:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is provided. For example, if a radiologist interprets the X-ray but does not own the equipment, this modifier would be applicable.
2. Modifier TC - Technical Component: This is used when only the technical component of the service is provided. This would apply if the facility owns the equipment and performs the X-ray, but the interpretation is done elsewhere.
3. Modifier 59 - Distinct Procedural Service: This modifier may be used if the X-ray exam is performed in conjunction with another procedure, and it is necessary to indicate that the services are distinct and separate.
4. Modifier 76 - Repeat Procedure by Same Physician: If the X-ray exam needs to be repeated on the same day by the same provider, this modifier would be used to indicate the repeat service.
5. Modifier 77 - Repeat Procedure by Another Physician: Similar to Modifier 76, but used when the repeat procedure is performed by a different provider.
6. Modifier 52 - Reduced Services: If the procedure is partially reduced or eliminated at the discretion of the physician, this modifier would be appropriate.
7. Modifier 53 - Discontinued Procedure: This modifier is used if the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 99 - Multiple Modifiers: If more than one modifier is necessary to describe the service, Modifier 99 is used to indicate multiple modifiers.
These modifiers help clarify the specifics of the service provided and ensure accurate billing and reimbursement. It's crucial to apply the correct modifiers to avoid claim denials and ensure compliance with payer requirements.
Determining whether CPT code 70390 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region.
The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually. To ascertain if CPT code 70390 is covered, healthcare providers should verify its inclusion in the MPFS and review any specific local coverage determinations (LCDs) or national coverage determinations (NCDs) that may apply.
Additionally, MACs, which are responsible for processing Medicare claims, may have specific guidelines or requirements for the reimbursement of certain CPT codes, including 70390. Providers should consult their regional MAC for any additional documentation or criteria that must be met for successful reimbursement.
It is crucial to stay informed about any updates or changes to the MPFS and MAC guidelines to ensure compliance and optimize reimbursement processes.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including specific codes like 70390, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
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
