CPT code 76391 is used for MR elastography, a non-invasive imaging technique that measures tissue stiffness, aiding in the diagnosis of liver diseases.
CPT code 76391 is used for MR elastography, a specialized imaging technique that combines magnetic resonance imaging (MRI) with sound waves to create a visual map (elastogram) showing the stiffness of tissues in the body. This procedure is particularly useful for assessing liver fibrosis, as it helps healthcare providers determine the extent of liver damage without the need for a biopsy. By measuring the elasticity of tissues, MR elastography aids in diagnosing and monitoring conditions that affect tissue stiffness, providing valuable information for treatment planning.
For the CPT codes 76390 and 76391, the use of modifiers may be necessary to provide additional information about the service provided or to ensure proper billing. 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 indicates that the provider is billing for the interpretation of the test 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 indicates that the provider is billing for the use of equipment and facilities, not the interpretation.
3. Modifier 59 (Distinct Procedural Service): This modifier may be used if the procedure is distinct or independent from other services performed on the same day. It helps to indicate that the services are not bundled and should be reimbursed separately.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when the same procedure is repeated by the same physician on the same day. It indicates that the repeat procedure was necessary.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when the same procedure is repeated by a different physician on the same day. It indicates that the repeat procedure was necessary and performed by another provider.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although typically used for laboratory tests, this modifier can be applicable if the procedure is repeated for clinical reasons on the same day.
7. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. It indicates that the full service was not provided.
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. Documentation must support the substantial additional work and the reason for it.
These modifiers help ensure accurate billing and reimbursement by providing additional context to the services rendered. It is important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 76391 is subject to reimbursement considerations under Medicare.
To determine if this specific CPT code is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare.
Additionally, reimbursement can vary based on the policies of the local Medicare Administrative Contractor (MAC), which administers Medicare claims for specific regions.
Providers should consult the MPFS and their respective MAC's guidelines to confirm the reimbursement status of CPT code 76391.
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