CPT code 90386 is a medical code used to identify the administration of Rh immunoglobulin for specific patient care situations.
CPT code 90386 is used to describe the administration of Rh immune globulin intravenously. This code is specifically for the intravenous delivery of Rh immunoglobulin, which is a blood product used to prevent Rh immunization, a condition that can occur when an Rh-negative individual is exposed to Rh-positive blood. This is particularly important in pregnancy, where an Rh-negative mother may develop antibodies against Rh-positive fetal blood cells. The use of this code helps healthcare providers accurately document and bill for the administration of this specific treatment.
For CPT code 90386, which pertains to Rh immune globulin administered intravenously, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required. It may be applicable if the administration of Rh immune globulin intravenously involves additional complexity or time.
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. It may be applicable if an E/M service is provided in conjunction with the administration of Rh immune globulin.
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 applicable if the administration of Rh immune globulin is performed in a different session or encounter from other services.
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 provider. It may be applicable if the Rh immune globulin administration is repeated on the same day.
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 a different provider. It may be applicable if the Rh immune globulin administration is repeated on the same day by another provider.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although typically used for laboratory tests, this modifier may be relevant if the administration involves repeated diagnostic testing as part of the procedure.
7. Modifier 99 (Multiple Modifiers): This modifier is used when two or more modifiers are necessary to describe the service. It may be applicable if multiple modifiers are required to accurately represent the circumstances of the Rh immune globulin administration.
These modifiers should be used in accordance with payer guidelines and specific clinical scenarios to ensure accurate billing and reimbursement.
The CPT code 90386 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. However, whether CPT code 90386 is reimbursed by Medicare can depend on several factors, including coverage determinations made by Medicare Administrative Contractors (MACs). MACs are responsible for processing Medicare claims and have the authority to make local coverage decisions that can affect reimbursement. Therefore, while the MPFS provides a baseline for potential reimbursement, the final determination for CPT code 90386 may vary based on the specific MAC's policies and any applicable local coverage determinations (LCDs). Healthcare providers should consult their respective MAC for the most accurate and up-to-date information regarding reimbursement for this specific CPT code.
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 90386. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and ensure you're receiving the full reimbursement you deserve.
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
