CPT code 33617 is used for the procedure involving the repair of a single ventricle in the heart, essential for accurate medical documentation.
CPT code 33617 is used to describe the surgical procedure for repairing a single ventricle in the heart. This code is specifically assigned to operations that address congenital heart defects where only one functional ventricle is present. The procedure aims to improve the heart's ability to pump blood effectively by reconstructing or modifying the heart's structure to optimize its function. This complex surgery is typically performed by a cardiothoracic surgeon and is crucial for patients with certain types of congenital heart disease to enhance their quality of life and overall cardiac performance.
For CPT code 33617, "Repair single ventricle," the following modifiers may be applicable depending on the specific circumstances of the procedure and the billing requirements:
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 complications or other factors that increase the complexity of the surgery.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was carried out.
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 prevent bundling of services that are usually considered part of a single procedure.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure, each surgeon should report their distinct operative work by adding this modifier.
5. Modifier 66 - Surgical Team: This is used when a complex procedure requires the skills of several surgeons, often from different specialties, working together as a team.
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 when a patient needs to return to the operating room for a related procedure during the postoperative period of the initial surgery.
7. Modifier 80 - Assistant Surgeon: This is used when an assistant surgeon is required to help with the procedure.
8. Modifier 81 - Minimum Assistant Surgeon: This indicates that an assistant surgeon was required for a minimal portion of the procedure.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
These modifiers should be applied based on the specific details of the surgical procedure and the circumstances under which it was performed. Proper use of modifiers ensures accurate billing and reimbursement for the services provided.
The CPT code 33617 is subject to reimbursement by Medicare, but its reimbursement status 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) in your region.
The MPFS provides a comprehensive list of services covered by Medicare, along with their respective reimbursement rates. However, coverage and payment can vary based on local policies established by the MAC, which administers Medicare claims and determines coverage specifics in different geographic areas.
Therefore, it is essential for healthcare providers to verify the reimbursement status of CPT code 33617 with their local MAC to ensure compliance and accurate billing.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 33617, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and maximize your revenue.
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