CPT code 74290 is for a contrast x-ray of the gallbladder, a diagnostic procedure to visualize gallbladder structure and function using contrast material.
CPT code 74290 is used for a diagnostic procedure involving a contrast x-ray of the gallbladder. This procedure, also known as a cholecystography, involves the use of a contrast medium to enhance the visibility of the gallbladder on an x-ray image. The contrast helps in outlining the gallbladder, allowing healthcare providers to assess its structure and function, and to identify any abnormalities such as gallstones or inflammation. This code is specifically used to document and bill for the technical and professional components of performing and interpreting this imaging study.
For the CPT codes 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 when the physician is providing only the interpretation of the results, 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 when the facility is providing the equipment, supplies, and technical staff necessary for the procedure.
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 normally 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 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 are used to provide additional information about the service performed and ensure accurate billing and reimbursement. It is important to review the specific circumstances of each procedure to determine the appropriate use of modifiers.
As of the latest updates, the CPT code 74290 is not reimbursed by Medicare under the Medicare Physician Fee Schedule (MPFS). This means that healthcare providers should not expect direct reimbursement for this specific code when billing Medicare.
It's important to note that reimbursement policies can vary based on the region and the specific guidelines set by the Medicare Administrative Contractor (MAC) responsible for that area. Providers should consult their local MAC for any potential exceptions or additional guidance regarding the billing and reimbursement of CPT code 74290.
Regularly reviewing updates from both the MPFS and MAC is crucial for staying informed about any changes in reimbursement policies.
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