CPT code 72190 is used to identify and describe an X-ray exam of the pelvis, helping healthcare providers document and manage medical procedures.
CPT code 72190 is used to describe an X-ray examination of the pelvis. This code is specifically for a radiological procedure where images of the pelvic region are captured to help diagnose or assess conditions affecting the bones, joints, or surrounding tissues in that area. The X-ray can provide valuable insights into issues such as fractures, arthritis, or other abnormalities. This code is utilized by healthcare providers to ensure accurate billing and documentation of the X-ray service provided.
When considering the use of modifiers for CPT codes related to X-ray exams of the pelvis, it is essential to understand the context in which the service is provided. 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, such as the interpretation of the X-ray by a radiologist, without the technical component (e.g., the use of equipment).
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is provided, such as the use of the X-ray equipment and the technician's services, without the professional interpretation.
3. Modifier 59 (Distinct Procedural Service): This modifier may be used if the X-ray exam of the pelvis 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): This modifier is applicable if the X-ray exam is repeated on the same day by the same provider due to medical necessity.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used if the X-ray exam is repeated on the same day by a different provider.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although typically used for laboratory tests, this modifier can sometimes be relevant if the X-ray is repeated for clinical reasons, not due to equipment failure or quality issues.
7. Modifier 52 (Reduced Services): This modifier is used when the service provided is less than what is typically required for the procedure, such as a limited view of the pelvis.
8. Modifier 53 (Discontinued Procedure): This modifier is applicable if the procedure is started but discontinued due to patient safety or other extenuating circumstances.
9. Modifier 99 (Multiple Modifiers): This modifier is used when more than four modifiers are necessary to describe the service accurately.
The use of these modifiers depends on the specific circumstances of the service provided and should be carefully considered to ensure accurate billing and reimbursement. Always refer to the latest coding guidelines and payer-specific policies when applying modifiers.
The CPT code 72190 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The reimbursement rates for this code can vary based on geographic location and other factors, which are determined by the Medicare Administrative Contractor (MAC) responsible for the specific region.
Healthcare providers should consult their local MAC for precise reimbursement details and ensure compliance with any specific billing requirements or documentation standards that may apply to CPT code 72190.
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