CPT code 90288 is a code used to identify the administration of Botulism immunoglobulin intravenously for healthcare documentation and reimbursement purposes.
CPT code 90288 is used to describe the administration of botulism immune globulin intravenously. This code is specifically utilized when a healthcare provider administers a dose of immune globulin to a patient to treat or prevent botulism, a serious illness caused by a toxin that attacks the body's nerves. The immune globulin helps neutralize the toxin, providing critical intervention in cases of suspected or confirmed botulism exposure. This code is essential for accurate billing and documentation of the procedure within the healthcare revenue cycle.
For CPT code 90288, which pertains to Botulism Immune Globulin Intravenous (Human), the following modifiers may be applicable depending on the specific circumstances of the service provided:
1. 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.
2. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: This modifier is used when a significant, separately identifiable evaluation and management service is performed by the same physician on the same day as 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 identify procedures/services that are not normally reported together but are appropriate under the circumstances.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: 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 or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by another physician or 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.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper documentation is essential to justify the use of any modifier.
CPT code 90288 is associated with a specific medical service. To determine if this code is reimbursed by Medicare, one must refer to the Medicare Physician Fee Schedule (MPFS), which provides a comprehensive list of services covered by Medicare and their respective reimbursement rates. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in interpreting national Medicare policies and determining coverage specifics at the regional level.
For CPT code 90288, it is essential to verify its status on the MPFS to see if it is listed and has an assigned reimbursement rate. If it is not listed, it may not be reimbursed by Medicare. Furthermore, since MACs can have regional variations in coverage, it is advisable to consult the specific MAC for your region to confirm whether they provide reimbursement for this code. This dual approach ensures that healthcare providers have accurate and up-to-date information regarding Medicare reimbursement for CPT code 90288.
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