CPT code 92612 is used for a procedure involving a video endoscopic evaluation of swallowing function, often referred to as FEES.
CPT code 92612 is used to describe a procedure known as a flexible endoscopic evaluation of swallowing (FEES). This procedure involves using a flexible endoscope to visually assess a patient's swallowing function. It is typically performed by a speech-language pathologist or a physician to evaluate the anatomy and physiology of the swallowing mechanism. The procedure helps in diagnosing swallowing disorders and planning appropriate treatment strategies. The "vid" in the description indicates that the procedure is often recorded on video for further analysis and documentation.
For CPT code 92612, which pertains to endoscopic evaluation of swallowing function, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the physician or healthcare provider is billing only for the professional component of the service, such as the interpretation of the results.
2. Modifier TC - Technical Component: This modifier is applied when billing for the technical component of the service, which includes the use of equipment and the technician's time.
3. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the discretion of the physician or healthcare provider.
4. 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.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day.
7. 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 procedure room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period.
These modifiers help clarify the specifics of the service provided and ensure accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 92612 is associated with a procedure that may be reimbursed by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource for determining whether a specific CPT code is covered and the reimbursement rate. The MPFS outlines the payment policies and rates for services provided to Medicare beneficiaries.
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 based on local policies. Therefore, whether CPT code 92612 is reimbursed can vary depending on the MAC's local coverage determinations (LCDs) and the specific circumstances of the service provided.
Healthcare providers should consult the MPFS and their respective MAC's guidelines to confirm the reimbursement status of CPT code 92612 and ensure compliance with any specific documentation or billing requirements.
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