CPT code 38790 is a medical code used to identify the injection for lymphatic x-ray procedures, facilitating accurate documentation and communication.
CPT code 38790 is an injection procedure designed to introduce a contrast agent for lymphatic x-ray imaging, which helps visualize the lymphatic system to diagnose abnormalities or blockages.
For CPT code 38790, which involves an injection for a lymphatic x-ray, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 26 - Professional Component: This modifier is used when the physician provides only the professional component of the service, such as the interpretation of the x-ray, and not the technical component.
2. Modifier TC - Technical Component: This modifier is used when the billing is for the technical component of the service, such as the use of equipment and supplies, without the professional interpretation.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It may be necessary if the injection is performed in conjunction with other procedures that are not typically reported together.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if the procedure is repeated by a different physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used if the patient needs to return for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if the injection is unrelated to the original procedure and occurs during the postoperative period.
8. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service accurately.
These modifiers help provide additional information about the service performed and ensure accurate billing and reimbursement. It is important to review the specific circumstances of each case to determine the appropriate modifiers to use.
CPT code 38790, which involves an injection for a lymphatic x-ray, is subject to reimbursement considerations under Medicare. To determine if this specific CPT code is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with their respective reimbursement rates.
Additionally, it is important to consult with the local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide guidance on coverage specifics, including any local coverage determinations (LCDs) that may affect reimbursement for CPT code 38790. MACs may have varying policies based on geographic regions, so their input is crucial for understanding whether this code is reimbursed in a particular area. Always ensure that the service meets Medicare's medical necessity criteria and documentation requirements to facilitate successful reimbursement.
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