CPT code 76604 is used for a chest ultrasound exam, helping healthcare providers diagnose and monitor conditions by capturing detailed images.
CPT code 76604 is used to describe an ultrasound examination of the chest. This procedure involves using high-frequency sound waves to create images of the structures within the chest, such as the lungs, pleura, and other thoracic components. It is a non-invasive diagnostic tool that helps healthcare providers assess and diagnose conditions related to the chest area, such as fluid accumulation, masses, or other abnormalities. This code is typically used by radiologists or other qualified healthcare professionals who perform and interpret the ultrasound study.
For the CPT codes provided, here are the potential modifiers that could be applicable:
1. Modifier 26 (Professional Component): This modifier is used when the service provided is the professional component of a procedure, such as the interpretation of the ultrasound exam, separate from the technical component.
2. Modifier TC (Technical Component): This modifier is used when the service provided is the technical component of a procedure, such as the use of equipment and technician services, separate from the professional component.
3. Modifier 59 (Distinct Procedural Service): This modifier may be used if the ultrasound exam is performed as a distinct service from other procedures on the same day. It indicates that the procedure is not normally reported together but is appropriate under the circumstances.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is applicable if the ultrasound exam is repeated by the same physician on the same day for the same patient.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used if the ultrasound exam is repeated by a different physician on the same day for the same patient.
6. Modifier 52 (Reduced Services): This modifier is used when the service provided is partially reduced or eliminated at the discretion of the physician.
7. Modifier 53 (Discontinued Procedure): This modifier is applicable if the 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 in accurately reporting the specifics of the service provided and ensure appropriate reimbursement. It is essential to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 76604 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The reimbursement for this code, like others, is subject to the specific policies and guidelines set forth by the Medicare Administrative Contractor (MAC) in your region.
These contractors are responsible for processing claims and determining the local coverage determinations (LCDs) that may affect reimbursement. It's important for healthcare providers to verify the specific reimbursement rates and any additional requirements or documentation needed by consulting the MAC that services their area.
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