CPT code 33960 is used for procedures involving external circulation assistance, crucial for patients needing support with blood flow.
CPT code 33960 is used to describe the management of a patient who is receiving prolonged extracorporeal circulation and/or ventricular assist, typically in a critical care setting. This code is often applied when a healthcare provider is overseeing the use of devices that support or replace the function of the heart and lungs, such as during extracorporeal membrane oxygenation (ECMO) or when a ventricular assist device (VAD) is in use. The code indicates that the provider is responsible for the ongoing assessment and management of the patient's circulatory support, ensuring that the external circulation assist is functioning correctly and effectively supporting the patient's cardiovascular system.
For CPT code 33960, which pertains to external circulation assist, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required. It may be applicable if the external circulation assist procedure involves significantly more effort or complexity.
2. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. It might be relevant if the external circulation assist was not performed to its full extent.
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 can be applied if the external circulation assist is performed separately from other procedures.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when a procedure or service is repeated by the same physician. It may be applicable if the external circulation assist needs to be performed more than once on the same day.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a procedure or service is repeated by a different physician. It might be used if another healthcare provider performs the external circulation assist again on the same day.
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. It could be relevant if the external circulation assist is part of such a scenario.
7. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when a procedure or service is performed during the postoperative period of another procedure, but is unrelated to the original procedure. It might be applicable if the external circulation assist is unrelated to the initial surgery.
These modifiers help provide additional context and specificity to the billing and coding process, ensuring accurate representation of the services provided. Always consult the latest coding guidelines and payer-specific policies to determine the appropriate use of modifiers.
CPT code 33960 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific policies of the Medicare Administrative Contractor (MAC) in your region.
The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. However, coverage can vary based on local coverage determinations (LCDs) set by MACs, which are responsible for processing Medicare claims and ensuring compliance with Medicare guidelines.
Therefore, it is essential to verify with the relevant MAC to determine if CPT code 33960 is reimbursed in your specific locality and under what conditions.
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