CPT code 00562 is used for anesthesia services during heart surgery with a pump for patients aged 1 and older.
CPT code 00562 is used to describe anesthesia services provided during heart surgery that involves the use of a pump oxygenator for patients aged one year and older. This code is specifically utilized by anesthesiologists to indicate the type of anesthesia care required for complex cardiac procedures where a heart-lung machine is employed to maintain circulation and oxygenation during surgery.
For CPT code 00562, which pertains to anesthesia services for heart surgery with pump assistance for patients aged 1 year and older, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide the service is substantially greater than typically required. This could be due to unusual factors such as patient condition or complexity of the procedure.
2. Modifier 23 - Unusual Anesthesia: This is applicable when a procedure that usually requires no anesthesia or local anesthesia must be performed under general anesthesia due to unusual circumstances.
3. Modifier 47 - Anesthesia by Surgeon: If the surgeon administers the anesthesia, this modifier is used to indicate that the anesthesia was provided by the surgeon rather than an anesthesiologist.
4. 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.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This is used when the same procedure is repeated by the same provider.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is used when the same procedure is repeated by a different provider.
7. 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 when the patient must return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when an unrelated procedure is performed by the same physician during the postoperative period.
9. Modifier AA - Anesthesia Services Performed Personally by Anesthesiologist: This indicates that the anesthesia services were personally performed by an anesthesiologist.
10. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals: This is used when an anesthesiologist is directing multiple anesthesia procedures.
11. Modifier QS - Monitored Anesthesia Care Service: This indicates that the service provided was monitored anesthesia care.
12. Modifier QX - CRNA Service: With Medical Direction by a Physician: This is used when a Certified Registered Nurse Anesthetist (CRNA) provides the service under the medical direction of a physician.
13. Modifier QY - Medical Direction of One CRNA by an Anesthesiologist: This indicates that an anesthesiologist is directing one CRNA.
14. Modifier QZ - CRNA Service: Without Medical Direction by a Physician: This is used when a CRNA provides the service without the medical direction of a physician.
These modifiers help provide additional information about the circumstances under which the anesthesia service was provided, ensuring accurate billing and reimbursement.
CPT code 00562 is related to anesthesia services for heart surgery with pump assistance for patients aged 1 and older. Whether this specific CPT code is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the regional Medicare Administrative Contractor (MAC).
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. If CPT code 00562 is listed in the MPFS, it is generally eligible for reimbursement, provided that the service is deemed medically necessary and meets all other Medicare coverage criteria.
However, the final determination of reimbursement is often influenced by the MAC, which is responsible for processing Medicare claims and making coverage decisions in specific geographic areas. Each MAC may have its own local coverage determinations (LCDs) that can affect whether a particular service is reimbursed.
Healthcare providers should verify the inclusion of CPT code 00562 in the MPFS and consult with their regional MAC to ensure compliance with any specific coverage policies or documentation requirements that may impact reimbursement.
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