CPT code 74235 is for a procedure to remove an obstruction from the esophagus, ensuring clear passage for food and liquids.
CPT code 74235 is used to describe a medical procedure that involves the removal of an obstruction in the esophagus. This procedure is typically performed when there is a blockage that prevents normal swallowing or passage of food and liquids. The obstruction could be due to various causes such as a foreign object, a growth, or a narrowing of the esophagus. The removal process may involve endoscopic techniques, where a flexible tube with a camera and tools is inserted through the mouth to reach and clear the blockage, thereby restoring normal esophageal function.
When considering whether a CPT code requires any modifiers, it's important to understand the context of the procedure and the specific circumstances under which it was performed. Below is a list of potential modifiers that could be applicable to the given CPT codes:
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 procedure involves both a technical and professional component, and the provider is only responsible for the professional aspect.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed. It applies if the procedure involves both a technical and professional component, and the provider is only responsible for the technical aspect.
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 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 another physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same session. It indicates that the procedure is one of several performed on the same day.
7. 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.
8. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
9. 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.
10. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when a procedure or service during the postoperative period was planned prospectively or at the time of the original procedure.
11. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): This modifier is used when a related procedure is performed during the postoperative period of the initial procedure.
12. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period.
The applicability of these modifiers depends on the specific circumstances of the procedure and the billing guidelines of the payer. Proper documentation is essential to support the use of any modifier.
CPT code 74235 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS).
Whether this code is reimbursed by Medicare can depend on various factors, including the specific policies of the Medicare Administrative Contractor (MAC) that processes claims in your region.
Each MAC may have different guidelines and coverage determinations, which can affect the reimbursement status of CPT code 74235.
It is essential for healthcare providers to verify the reimbursement status with their local MAC and review the MPFS for the most current information regarding allowable charges and coverage criteria.
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 CPT code 74235, RevFind offers unparalleled precision in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and optimize your financial outcomes.
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
