CPT CODES

CPT Code 33918

CPT code 33918 is used for the procedure involving the repair of pulmonary atresia, a heart defect affecting blood flow to the lungs.

Table of Contents
What is CPT Code 33918
Does CPT 33918 Need a Modifier?
CPT Code 33918 Medicare Reimbursement
Are You Being Underpaid for 33918 CPT Code?
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What is CPT Code 33918

CPT code 33918 is used to describe the surgical procedure for repairing pulmonary atresia, a congenital heart defect where the pulmonary valve does not form properly, obstructing blood flow from the heart to the lungs. This code is utilized by healthcare providers to document and bill for the intricate surgical intervention required to correct this defect, which typically involves creating a pathway for blood to reach the lungs, thereby improving oxygenation and overall cardiac function.

Does CPT 33918 Need a Modifier?

For CPT code 33918, which pertains to the repair of pulmonary atresia, the following modifiers may be applicable:

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 factors such as increased intensity, time, technical difficulty, severity of the patient's condition, or physical and mental effort required.

2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier is used to indicate that multiple surgeries were 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 used to identify procedures/services that are not normally 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 procedure, this modifier is used to indicate the collaborative effort.

5. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the services 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 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure performed during the postoperative period is unrelated to the original procedure.

These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific policies, as requirements may vary.

CPT Code 33918 Medicare Reimbursement

CPT code 33918, which involves a specific medical procedure, is subject to reimbursement considerations under Medicare. To determine if this code is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and procedures covered by Medicare, along with their respective reimbursement rates.

Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific guidance on whether CPT code 33918 is reimbursed. They may also offer insights into any local coverage determinations (LCDs) that could affect reimbursement.

Healthcare providers should verify the inclusion of CPT code 33918 in the MPFS and consult their respective MAC for the most accurate and up-to-date information regarding reimbursement eligibility and any specific billing requirements.

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