CPT code 33928 is used for the removal and replacement of a total artificial heart system in healthcare procedures.
CPT code 33928 is used to describe the procedure for the removal and replacement of a total artificial heart system. This code is applicable when a healthcare provider needs to surgically remove an existing total artificial heart device and replace it with a new one. The procedure is typically performed in patients who have severe heart failure and have previously received a total artificial heart as a bridge to transplantation or as a destination therapy. The code ensures that the complex nature of this surgical intervention is accurately documented for billing and insurance purposes.
For CPT code 33928, which involves the removal and replacement of a total heart system, 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 apply if there are unforeseen complications or additional work involved in the removal and replacement process.
2. Modifier 52 (Reduced Services): If the procedure is partially reduced or eliminated at the physician's discretion, this modifier may be used. For instance, if only part of the heart system is replaced, this modifier would be appropriate.
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 may be necessary if multiple procedures are performed that are not typically reported together.
4. Modifier 76 (Repeat Procedure by Same Physician): If the procedure needs to be repeated by the same physician, this modifier would be applicable. This could occur if there are complications necessitating a repeat of the procedure.
5. 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 if the patient needs to return to the operating room for a related procedure during the postoperative period.
6. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): If an unrelated procedure is performed by the same physician during the postoperative period, this modifier would be used.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is essential to review the specific payer guidelines, as the use of modifiers can vary based on the payer's policies.
CPT code 33928, which involves the removal and replacement of a total heart system, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines the reimbursement rates for services covered under Medicare Part B. To ascertain if CPT code 33928 is reimbursed, healthcare providers should consult the MPFS to verify if this specific code is listed and the associated reimbursement rate.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make coverage determinations for their respective jurisdictions. Therefore, it is essential for healthcare providers to check with their local MAC to confirm if CPT code 33928 is covered and to understand any specific billing guidelines or documentation requirements that may apply.
In summary, while CPT code 33928 can be reimbursed by Medicare, providers must verify its inclusion in the MPFS and consult their local MAC for any additional coverage criteria or requirements.
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 33928, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
