CPT code 71035 is for a chest X-ray with special views, used to capture detailed images of the chest for diagnostic purposes.
CPT code 71035 is used to describe a chest X-ray that involves special views. This means that the X-ray is not just a standard front or side view, but includes additional angles or positions to provide a more comprehensive examination of the chest area. These special views are typically ordered by a healthcare provider when there is a need to investigate specific areas of the chest more thoroughly, such as when looking for abnormalities or confirming a diagnosis.
When considering the use of modifiers for CPT codes related to chest x-rays, such as 71034 and 71035, it's important to understand the context in which these procedures are performed. Modifiers are used to provide additional information about the performed service, and they 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 appropriate.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is provided. It applies when the facility provides the equipment and technical staff but not the interpretation.
3. Modifier 59 (Distinct Procedural Service): This modifier may be used if the chest x-ray is performed as a distinct service from other procedures on the same day. It indicates that the procedure is not part of a more comprehensive service.
4. Modifier 76 (Repeat Procedure by Same Physician): If the same physician needs to perform the chest x-ray more than once on the same day, this modifier is used to indicate that the procedure was repeated.
5. Modifier 77 (Repeat Procedure by Another Physician): Similar to Modifier 76, but used when a different physician performs the repeat procedure on the same day.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although primarily used for lab tests, this modifier can sometimes be applicable if the x-ray is repeated for clinical reasons, not due to equipment malfunction or error.
7. Modifier 52 (Reduced Services): This modifier is used when the service is partially reduced or eliminated at the physician's discretion. It indicates that the full service described by the CPT code was not performed.
8. Modifier 53 (Discontinued Procedure): If the procedure is started but discontinued due to patient safety or other reasons, this modifier is used to indicate that the procedure was not completed.
Each modifier provides specific information that can impact billing and reimbursement, so it's crucial to apply them accurately based on the circumstances of the service provided.
The CPT code 71035 is subject to reimbursement considerations under Medicare, but whether it is reimbursed can depend on several factors, including the Medicare Physician Fee Schedule (MPFS) and the guidelines set by the local Medicare Administrative Contractor (MAC).
The MPFS provides a list of fees that Medicare uses to reimburse physicians and other healthcare providers for services, and it is updated annually to reflect changes in policy and practice.
For CPT code 71035, you would need to check the current MPFS to determine if it is listed and what the reimbursement rate might be. Additionally, each MAC, which administers Medicare benefits in specific regions, may have its own coverage policies and guidelines that affect whether and how this code is reimbursed.
Therefore, it is crucial for healthcare providers to consult both the MPFS and their local MAC's policies to ascertain the reimbursement status of CPT code 71035.
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 71035. Schedule a demo today to see how RevFind can help you maximize reimbursements from each payer.
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