CPT code 33464 is a medical code used to describe the procedure of repairing the tricuspid valve to improve heart function.
CPT code 33464 is used to describe a surgical procedure known as a valvuloplasty of the tricuspid valve. This procedure involves the repair of the tricuspid valve, which is one of the four valves in the heart. The tricuspid valve is located between the right atrium and the right ventricle, and its primary function is to ensure the proper flow of blood from the atrium to the ventricle. A valvuloplasty is typically performed to correct issues such as valve stenosis (narrowing) or regurgitation (leakage), which can impede normal blood flow and lead to various cardiac complications. The procedure aims to restore normal valve function, thereby improving the patient's heart efficiency and overall cardiovascular health.
For CPT code 33464, which pertains to valvuloplasty of the tricuspid valve, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to increased complexity or additional time spent.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was performed.
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 often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is applicable.
5. Modifier 66 - Surgical Team: If the procedure requires a surgical team due to its complexity, this modifier is used to indicate that a team approach was necessary.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same physician repeats a procedure on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated by a different physician on the same day.
8. 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 a patient returns to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
13. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the service, this modifier indicates that multiple modifiers are being used.
These modifiers should be applied based on the specific details and circumstances of the procedure performed. Proper use of modifiers ensures accurate billing and reimbursement.
CPT code 33464 is subject to reimbursement by Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) for the region in which the service is provided.
The MPFS outlines the payment rates for services covered under Medicare Part B, and each MAC may have additional local coverage determinations that affect reimbursement.
Therefore, healthcare providers should verify the reimbursement status of CPT code 33464 by consulting the MPFS and their respective MAC's policies to ensure compliance and proper billing practices.
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