CPT code 74247 is for a contrast X-ray of the upper gastrointestinal tract, used to diagnose issues in the esophagus, stomach, and duodenum.
CPT code 74247 is used to describe a diagnostic procedure known as a contrast X-ray of the upper gastrointestinal (GI) tract. This procedure 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, known as the duodenum. A contrast material, usually a barium-based substance, is ingested by the patient to help highlight these areas on the X-ray images. This allows healthcare providers to better visualize and assess the structure and function of the upper GI tract, aiding in the diagnosis of conditions such as ulcers, tumors, or blockages.
When considering whether a CPT code requires modifiers, it's important to understand the context of the procedure and the specific circumstances under which it was performed. 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. For example, if a radiologist interprets the X-ray but does not own the equipment, this modifier would be appropriate.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. This would apply if the facility owns the equipment and performs the X-ray, but the interpretation is done separately.
3. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. If the X-ray was not completed as initially planned, this modifier might be applicable.
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. If the X-ray needed to be repeated on the same day, this modifier would be relevant.
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. If another physician needed to repeat the X-ray, this modifier would apply.
6. 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. If the X-ray was performed in conjunction with other procedures, this modifier might be necessary to clarify its distinct nature.
7. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for laboratory tests, if the X-ray is considered a diagnostic test and needs to be repeated for clinical reasons, this modifier could be applicable.
Each modifier should be used based on the specific circumstances surrounding the procedure, and proper documentation should support the use of any modifier to ensure accurate billing and reimbursement.
The CPT code 74247 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The reimbursement rates and coverage details for this specific CPT code can vary based on geographic location and other factors, which are determined by the respective Medicare Administrative Contractor (MAC) for the region.
Healthcare providers should consult their local MAC to obtain precise reimbursement information and ensure compliance with Medicare billing requirements for CPT code 74247.
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