CPT code 33619 is used for the procedure involving the repair of a single ventricle in the heart, crucial for accurate medical documentation.
CPT code 33619 is used to describe the surgical procedure for repairing a single ventricle in the heart. This code is typically utilized in cases where a patient has a congenital heart defect that results in only one functional ventricle instead of the usual two. The procedure aims to improve the heart's ability to pump blood effectively throughout the body by reconstructing or modifying the existing ventricle. This complex surgery is often part of a series of operations designed to optimize cardiac function in patients with single ventricle physiology.
For CPT code 33619, "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. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that multiple procedures were carried out. It helps in identifying that the procedure is part of a series of procedures.
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 identify procedures that are not typically reported together but are appropriate under the circumstances.
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 modifier is used when a complex procedure requires the skills of several physicians, often of 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 requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
7. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to assist the primary surgeon during the procedure.
8. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required on a limited basis during the procedure.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required, and a qualified resident surgeon is not available.
Each modifier should be used in accordance with the specific guidelines and documentation requirements to ensure accurate billing and reimbursement.
CPT code 33619, which involves a specific medical procedure, is subject to reimbursement considerations under Medicare. To determine if this code is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually.
Additionally, it is crucial to consult with the relevant Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies for CPT code 33619. They may have local coverage determinations (LCDs) that affect whether this code is reimbursed and under what circumstances. Therefore, verifying with both the MPFS and your MAC will ensure accurate and up-to-date information regarding the reimbursement status of CPT code 33619.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including CPT code 33619, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
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