CPT code 75790 is for imaging to visualize an arteriovenous (A-V) shunt, helping healthcare providers assess blood flow between arteries and veins.
CPT code 75790 is used to describe the radiological supervision and interpretation of an arteriovenous (A-V) shunt imaging procedure. This code is specifically utilized when a healthcare provider performs imaging to visualize an A-V shunt, which is a connection between an artery and a vein. The purpose of this imaging is to assess the functionality and patency of the shunt, often used in patients undergoing dialysis. The procedure involves the use of contrast material to enhance the visibility of the shunt on imaging studies, allowing the radiologist to interpret the results and provide a detailed report on the condition of the shunt.
When considering the use of modifiers for the CPT codes provided, it is essential to understand the context of the procedure and the specific circumstances under which it is performed. Below 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 providing only the interpretation of the x-ray or visualization without owning the equipment.
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 owns the equipment and is billing for the use of the equipment and the technician's services.
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.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a procedure or service is repeated by another physician or qualified healthcare professional subsequent to the original procedure.
6. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same session. It helps indicate that more than one procedure was performed.
7. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
8. 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.
9. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required.
10. Modifier 63 (Procedure Performed on Infants less than 4 kg): This modifier is used when procedures are performed on neonates or infants up to a present body weight of 4 kg to indicate the increased complexity of the service.
The use of these modifiers depends on the specific details of the procedure, the setting, and the payer requirements. It is crucial to review payer policies and guidelines to ensure appropriate modifier usage.
The CPT code 75790 is indeed reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The reimbursement rates and coverage specifics for this code can vary depending on the region and the specific Medicare Administrative Contractor (MAC) responsible for processing claims in that area.
Each MAC may have slightly different policies or interpretations regarding the documentation and medical necessity requirements for CPT code 75790, so it is crucial for healthcare providers to verify the guidelines set forth by their respective MAC to ensure proper reimbursement.
Additionally, providers should regularly check for updates to the MPFS to stay informed about any changes in reimbursement rates or policies related to this CPT code.
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 specific codes like 75790, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and secure your financial health.
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
