CPT code 33976 is used for procedures involving the implantation of a ventricular device, crucial for heart function support.
CPT code 33976 is used to describe the procedure of implanting a ventricular assist device (VAD). This code is specifically assigned to the surgical insertion of a mechanical pump that helps support heart function and blood flow in individuals with weakened hearts. The device is typically used for patients with severe heart failure, either as a bridge to heart transplantation or as a long-term solution for those who are not candidates for a transplant. The procedure involves placing the device in the chest and connecting it to the heart and blood vessels, allowing it to take over the pumping action of the heart's ventricles.
For CPT code 33976, which involves the implantation of a ventricular device, 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 patient complexity or unexpected complications during the procedure.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that the procedure was one of several 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 often used to bypass National Correct Coding Initiative (NCCI) edits.
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: If the procedure requires a surgical team due to its complexity, this modifier is used to reflect the involvement of multiple professionals.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by a different provider.
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: This modifier is 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: This modifier is 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: This modifier is used when an assistant surgeon is required to help with the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required on a minimal basis.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because 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.
CPT code 33976 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) in your region.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. If CPT code 33976 is listed in the MPFS, it indicates that Medicare recognizes the service for reimbursement, subject to the conditions and rates specified.
However, the final determination of reimbursement also involves the MAC, which is responsible for processing Medicare claims and providing guidance on coverage policies in specific geographic areas. Each MAC may have unique local coverage determinations (LCDs) that affect whether and how a particular service, such as one billed under CPT code 33976, is reimbursed.
Therefore, to ascertain if CPT code 33976 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and verify any relevant LCDs or other directives from their regional MAC. This ensures compliance with Medicare's reimbursement policies and helps optimize the revenue cycle management process.
Discover the power of precision with MD Clarity's RevFind software. Our advanced solution meticulously analyzes your contracts to identify underpayments, pinpointing discrepancies down to the CPT code level, including CPT code 33976, and by individual payer. Don't let underpayments slip through the cracks—schedule a demo today to see how RevFind can enhance 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
