CPT code 74283 is used for radiological exams to diagnose or assess intestinal obstructions, providing crucial insights into gastrointestinal health.
CPT code 74283 is used for a radiological procedure known as a "therapeutic radiological reduction of intussusception or obstruction." This code refers to a specific type of imaging-guided intervention where a radiologist uses imaging techniques, such as fluoroscopy, to help relieve an intestinal blockage or intussusception, which is a condition where a part of the intestine folds into another section. This procedure is typically performed to alleviate the obstruction without the need for surgical intervention, using techniques like air or contrast enemas to reduce the intussusception.
For the CPT codes provided, here is a list of potential modifiers that could be applicable, along with the reasons for their use:
1. Modifier 26 (Professional Component): This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the X-ray or therapeutic procedure, 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 indicates that the provider is billing for the use of equipment and supplies, 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 procedures are performed and need to be reported 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 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 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.
These modifiers help ensure accurate billing and reimbursement by providing additional information about the circumstances under which the service was provided. It's important to review payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 74283 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). Whether or not this code is reimbursed by Medicare can depend on several factors, including the specific guidelines and policies set forth by the Medicare Administrative Contractor (MAC) that governs the region where the service is provided.
Each MAC may have different coverage determinations and reimbursement rates for CPT code 74283, so it is essential for healthcare providers to verify the specific reimbursement details with their local MAC.
Additionally, providers should ensure that the service meets all necessary documentation and medical necessity requirements as outlined by Medicare to qualify for reimbursement.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including CPT code 74283, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
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