CPT code 73718 is for an MRI of the lower extremity without contrast, used to diagnose issues in the leg, knee, ankle, or foot.
CPT code 73718 is used to describe an MRI (Magnetic Resonance Imaging) procedure of the lower extremity, such as the leg, knee, or foot, performed without the use of contrast dye. This imaging technique provides detailed pictures of the structures within the lower extremity, including bones, muscles, and soft tissues, helping healthcare providers diagnose and assess conditions or injuries without the need for invasive procedures.
When considering the use of modifiers for the given CPT codes, it's important to understand the context of the service provided and any specific circumstances that might necessitate a modifier. 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 being billed. It is applicable if the physician is interpreting the results but not providing the technical component.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed. It applies if the facility is providing the equipment and technical staff but not 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 may be necessary if multiple imaging services are performed and need to be billed separately.
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 another physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although more commonly used for lab tests, this modifier can be applicable if the imaging service is repeated for a valid medical reason.
7. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
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.
10. Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service): This modifier is used when an evaluation and management service is provided on the same day as another procedure, and it is significant and separately identifiable.
The use of these modifiers depends on the specific circumstances of the service provided, and accurate documentation is essential to justify their application. Always ensure compliance with payer-specific guidelines when applying modifiers.
The CPT code 73718 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services and procedures covered by Medicare, and CPT code 73718 is listed within this schedule.
However, the reimbursement amount can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting specific payment rates within their jurisdiction, so healthcare providers should consult their respective MAC for precise reimbursement details related to CPT code 73718.
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