CPT code 78190 is used for a test that evaluates how long platelets survive in the bloodstream, helping to diagnose blood disorders.
CPT code 78190 is used to describe a diagnostic test that evaluates platelet survival kinetics. This test involves tracking the lifespan and behavior of platelets in the bloodstream. By using specific markers or tracers, healthcare providers can assess how long platelets survive, how they are distributed, and how they are cleared from the body. This information is crucial for diagnosing and managing conditions related to abnormal platelet function or lifespan, such as certain bleeding disorders or thrombocytopenia.
For the CPT codes provided, the use of modifiers may be necessary depending on the specific circumstances of the procedure and the billing requirements. 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 imaging or study, 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 or provider owns the equipment and is responsible for the technical aspect of 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 may be necessary if multiple procedures are performed and need to be billed 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 a different physician or other qualified healthcare professional subsequent to the original procedure.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used for repeat laboratory tests performed on the same day to obtain subsequent (multiple) test results.
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 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided.
The necessity of these modifiers depends on the specific context of the service provided, including the setting, the provider's role, and any unique circumstances surrounding the procedure. Always consult the latest coding guidelines and payer-specific requirements to ensure accurate billing.
CPT code 78190 is not universally reimbursed by Medicare, as reimbursement can vary based on several factors, including geographic location and specific Medicare Administrative Contractor (MAC) policies.
The Medicare Physician Fee Schedule (MPFS) provides a framework for reimbursement rates, but it is ultimately the MACs that determine the coverage and payment specifics for each region.
Healthcare providers should consult their local MAC for detailed information on whether CPT code 78190 is reimbursed in their area and under what conditions.
Additionally, providers can reference the MPFS to understand the baseline reimbursement rates and any potential adjustments that may apply.
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 specific codes like 78190. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
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