CPT code 33975 is used for procedures involving the implantation of a ventricular assist device to support heart function.
CPT code 33975 is used to describe the surgical procedure for implanting a ventricular assist device (VAD). This code is specifically utilized when a healthcare provider performs the implantation of a mechanical pump that supports heart function and blood flow in individuals with weakened hearts. The procedure involves placing the device in the chest and connecting it to the heart to help circulate blood throughout the body, often used in patients with severe heart failure as a bridge to heart transplantation or as a long-term solution.
For CPT code 33975, which involves the implantation of a ventricular device, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
3. Modifier 59 (Distinct Procedural Service): Utilized to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 (Two Surgeons): Used when two surgeons work together as primary surgeons performing distinct parts of a procedure. Each surgeon should report their distinct operative work.
5. Modifier 66 (Surgical Team): Applied when a complex procedure requires the services of a surgical team, indicating that multiple professionals are involved in the procedure.
6. Modifier 76 (Repeat Procedure by Same Physician): Used when the same physician performs a procedure or service more than once on the same day.
7. Modifier 77 (Repeat Procedure by Another Physician): Applied when a procedure is repeated by a different physician on the same day.
8. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Used when a patient requires a return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
10. Modifier 80 (Assistant Surgeon): Applied when an assistant surgeon is required during the procedure.
11. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review the specific payer policies and guidelines to determine the appropriate use of modifiers for each case.
CPT code 33975 is associated with the implantation of a ventricular device. Whether this code is reimbursed by Medicare 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) for the region in which the service is provided.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. If CPT code 33975 is listed in the MPFS, it indicates that Medicare recognizes the service for reimbursement purposes. However, the actual reimbursement may vary based on geographical adjustments and other considerations.
Additionally, MACs, which are private organizations contracted by Medicare, play a crucial role in determining coverage and reimbursement specifics. They interpret national policies and may have local coverage determinations (LCDs) that affect whether and how a particular service, such as one billed under CPT code 33975, is reimbursed.
Therefore, to determine if CPT code 33975 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and review any relevant LCDs or guidance issued by their regional MAC. This ensures compliance with Medicare's reimbursement policies and helps optimize revenue cycle management.
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 33975, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and optimize your financial outcomes.
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
