CPT code 78267 is for a breath test using carbon-14 to assess and analyze metabolic functions, often used to diagnose gastrointestinal conditions.
CPT code 78267 is used to describe a breath test procedure that involves the collection and analysis of a breath sample using carbon-14 (C-14). This test is typically performed to assess certain metabolic functions or to diagnose specific gastrointestinal conditions. During the procedure, a patient ingests a substance labeled with C-14, and the breath sample is then analyzed to measure the presence of C-14, which helps in evaluating how the body processes the substance. This code covers both the administration of the test and the analysis of the breath sample.
For the CPT codes provided, here is a list of potential modifiers that could be applicable, along with the reasons for their use:
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 study, 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 equipment, supplies, and technical staff involved in 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 used to prevent bundling of services that are typically considered part of a larger procedure.
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 a different physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used when a laboratory test is repeated 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.
These modifiers help ensure accurate billing and reimbursement by providing additional information about the circumstances under which a service was provided. It is important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 78267 is subject to reimbursement considerations under Medicare. To determine if this specific code is reimbursed, 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 local policies set by the Medicare Administrative Contractor (MAC) in your region. Each MAC may have specific guidelines or coverage determinations that affect whether CPT code 78267 is reimbursed.
Therefore, it is essential for providers to consult both the MPFS and their respective MAC's policies to ascertain the reimbursement status of CPT code 78267.
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 78267. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see how RevFind can optimize your financial outcomes.
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
