CPT code 74240 is for an X-ray exam of the upper gastrointestinal tract using one contrast medium, aiding in diagnosing digestive issues.
CPT code 74240 is used to describe a specific type of X-ray procedure known as an upper gastrointestinal (GI) series with a single contrast. This diagnostic test involves taking X-ray images of the upper part of the digestive system, which includes the esophagus, stomach, and the first part of the small intestine. The "single contrast" refers to the use of a contrast material, typically a barium solution, that the patient ingests to help highlight these structures on the X-ray images. This procedure is commonly used to help diagnose issues such as ulcers, tumors, or other abnormalities in the upper GI tract.
When considering whether CPT codes 74235 and 74240 require any modifiers, it's important to understand the context of the procedure and the specific circumstances under which the service is provided. 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 only interpreting the results of the procedure.
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 supplies, but not the physician's interpretation.
3. Modifier 59 (Distinct Procedural Service): This modifier may be necessary if the procedure is distinct or independent from other services performed on the same day. It indicates that the procedure is not part of a more comprehensive service.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used if the same procedure is repeated by the same physician on the same day.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is applicable if the procedure is repeated by a different physician on the same day.
6. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
7. Modifier 53 (Discontinued Procedure): This modifier is used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required.
9. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same session by the same provider.
10. Modifier 99 (Multiple Modifiers): This modifier is used when two or more modifiers are necessary to describe the service provided.
The use of these modifiers depends on the specific details of the service provided, including the setting, the provider's role, and any unique circumstances surrounding the procedure. Always ensure compliance with payer-specific guidelines when applying modifiers.
The CPT code 74240 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 under Medicare Part B, and CPT code 74240 is listed within this schedule.
However, it's important to note that 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 healthcare providers should verify the reimbursement details with their respective MAC to ensure accurate billing and payment for CPT code 74240.
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