CPT code 73218 is for an MRI of the upper extremity without contrast, used to diagnose conditions in areas like the arm or shoulder.
CPT code 73218 is used to describe an MRI (Magnetic Resonance Imaging) procedure of the upper extremity, such as the arm or shoulder, performed without the use of contrast dye. This imaging technique is utilized to produce detailed images of the soft tissues, bones, and joints in the upper extremity, helping healthcare providers diagnose conditions like tears, fractures, or other abnormalities without the need for an injected contrast agent.
1. Modifier 26 - Professional Component
- This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the imaging study, not the technical component.
2. Modifier TC - Technical Component
- This modifier is applied when only the technical component of the service is being billed. It signifies that the provider is billing for the use of the equipment and the performance of the imaging study, excluding the interpretation.
3. 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. It is applicable when the procedures are not typically reported together but are appropriate under the circumstances.
4. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
5. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when a procedure or service is repeated by a different physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test
- Although primarily used for laboratory tests, this modifier can sometimes be applicable if the imaging study is repeated for clinical reasons, not due to equipment failure or quality issues.
7. Modifier 52 - Reduced Services
- This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. It indicates that the service provided was less than usually required.
8. Modifier 53 - Discontinued Procedure
- This modifier is used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
9. Modifier 22 - Increased Procedural Services
- This modifier is used when the work required to provide a service is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. Proper use of modifiers is crucial for compliance and optimal revenue cycle management.
CPT code 73218 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 respective Medicare Administrative Contractor (MAC) for each region. Healthcare providers should consult their local MAC for specific reimbursement details and any additional requirements that may apply to CPT code 73218.
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