CPT code 78586 is for a diagnostic test that captures a single image of the lungs using aerosol particles to assess lung function and airflow.
CPT code 78586 is used for a medical procedure that involves taking a single image of the lungs using an aerosol. This procedure is typically part of a nuclear medicine study where a patient inhales a radioactive aerosol, allowing healthcare providers to capture an image of the lungs. This imaging helps in assessing lung function and detecting any abnormalities in the airways or lung tissues.
When considering whether CPT codes 78585 and 78586 require any modifiers, it's important to understand the context of the service provided and the specific circumstances that might necessitate a modifier. Here 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. If the physician is only interpreting the imaging and not providing the technical component, this modifier would be appropriate.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed. It applies when the facility provides the equipment and technician services but not the physician's interpretation.
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 imaging services are provided and need to be distinguished from one another.
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 service 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 service was necessary and performed by another provider.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although primarily used for laboratory tests, this modifier can sometimes be applicable if the imaging is repeated for clinical reasons, ensuring that the repeat service is not due to a quality issue.
7. Modifier 99 (Multiple Modifiers): This modifier is used when two or more modifiers are necessary to describe the service provided. It indicates that multiple circumstances apply to the service.
These modifiers should be applied based on the specific details of the service provided and the billing requirements of the payer. Always ensure that the use of modifiers is compliant with payer policies and guidelines.
To determine if CPT code 78586 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the Medicare Administrative Contractor (MAC) specific to your region.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers on a fee-for-service basis. Each MAC, which administers Medicare benefits for a specific geographic area, may have additional local coverage determinations that affect reimbursement.
For CPT code 78586, you would need to verify its status on the MPFS to see if it is listed and what the reimbursement rate is. Additionally, checking with your local MAC will provide insights into any specific coverage policies or requirements that might influence whether this code is reimbursed.
It is important to stay updated with both the MPFS and MAC guidelines, as they can change annually or even more frequently.
Discover the power of MD Clarity's RevFind software in ensuring your practice receives every dollar it deserves. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 78586, RevFind provides unparalleled accuracy and insight 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
