CPT code 73220 is for an MRI of the upper extremity, performed both without and with contrast dye, aiding in detailed imaging for diagnosis.
CPT code 73220 is used to describe an MRI (Magnetic Resonance Imaging) procedure of the upper extremity, such as the arm or shoulder, that is performed both without and with contrast dye. This means that the imaging is done in two phases: initially, images are captured without the use of contrast material, and then additional images are taken after a contrast agent is injected into the patient's body. The contrast helps to enhance the visibility of tissues, blood vessels, and any abnormalities, providing a more detailed view for diagnostic purposes. This code is typically used when a more comprehensive evaluation of the upper extremity is required to assess conditions such as injuries, tumors, or other abnormalities.
When dealing with CPT codes for MRI procedures of the upper extremity, such as those with and without contrast, it's important to consider the appropriate use of modifiers to ensure accurate billing and reimbursement. Here is a list of potential modifiers that could be applied:
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 MRI results, not the technical component.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the use of the equipment and the performance of the MRI, excluding the interpretation.
3. Modifier 59 (Distinct Procedural Service): This modifier may be used if the MRI is performed in conjunction with another procedure that is not typically reported together. It signifies that the procedures are distinct and separate.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is applicable if the same MRI procedure is repeated on the same day by the same physician. It indicates that the repeat procedure was necessary.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when the same MRI procedure is repeated on the same day by a different physician. It indicates that the repeat procedure was necessary and performed by another provider.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although typically used for laboratory tests, this modifier can sometimes be applicable if the MRI is repeated for clinical reasons, such as verifying results or monitoring a condition.
7. Modifier GA (Waiver of Liability Statement Issued as Required by Payer Policy): This modifier is used when an Advance Beneficiary Notice (ABN) is on file, indicating that the patient has been informed that the service may not be covered by insurance.
8. Modifier GZ (Item or Service Expected to Be Denied as Not Reasonable and Necessary): This modifier is used when no ABN is on file, and the provider expects the service to be denied as not reasonable and necessary.
Each modifier serves a specific purpose and should be used in accordance with payer policies and the specific circumstances of the service provided. Proper use of modifiers can help ensure accurate billing and prevent claim denials.
CPT code 73220 is indeed reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The reimbursement for this code, like others, is subject to the specific policies and guidelines set forth by Medicare.
It's important to note that the reimbursement amount can vary based on geographic location and other factors, as determined by the Medicare Administrative Contractor (MAC) responsible for the region. Each MAC may have slightly different interpretations and implementations of Medicare policies, which can affect the reimbursement process for CPT code 73220.
Therefore, healthcare providers should consult their local MAC for precise reimbursement details and ensure compliance with any specific documentation or pre-authorization requirements that may apply.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 73220, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
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