CPT code 74220 is for an X-ray of the esophagus using one contrast medium, aiding in diagnosing swallowing issues or esophageal disorders.
CPT code 74220 is used to describe a medical procedure involving an X-ray examination of the esophagus using a single contrast medium. This procedure is typically performed to evaluate the structure and function of the esophagus, helping to identify any abnormalities such as strictures, blockages, or other issues. The "1cntrst" indicates that only one type of contrast material is used during the X-ray to enhance the visibility of the esophagus on the imaging results. This type of diagnostic imaging is crucial for healthcare providers to accurately diagnose and plan appropriate treatments for esophageal conditions.
When considering whether CPT codes 74210 and 74220 require any modifiers, it's important to evaluate the context of the service provided, payer-specific guidelines, and any special circumstances that might necessitate the use of modifiers. 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 providing the interpretation of the X-ray but 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 applies if the facility is billing for the use of equipment and technical staff but not the physician's interpretation.
3. Modifier 59 - Distinct Procedural Service: This modifier may be necessary if the X-ray is performed in conjunction with another procedure that is not typically reported together, and it is essential to indicate that the services are distinct and separate.
4. Modifier 76 - Repeat Procedure by Same Physician: If the X-ray needs to be repeated on the same day by the same physician, this modifier would be used to indicate that the repeat service was necessary.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if the X-ray is repeated on the same day by a different physician, indicating that the repeat was necessary.
6. Modifier 52 - Reduced Services: If the X-ray service was partially reduced or eliminated at the physician's discretion, this modifier would be used to indicate that the service was not performed in full.
7. Modifier 53 - Discontinued Procedure: If the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient, this modifier would be applicable.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for laboratory tests, if applicable, this modifier indicates that a repeat test was performed on the same day to obtain subsequent results.
It is crucial to verify with specific payer policies and guidelines to determine the necessity and appropriateness of these modifiers for each unique billing situation.
The CPT code 74220 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services covered under Medicare Part B, and CPT code 74220 is listed among those services.
However, reimbursement 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 it's important for healthcare providers to verify the reimbursement details with their respective MAC to ensure accurate billing and payment.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 74220, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and maximize your revenue.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
