CPT code 92613 is used for endoscopy swallow procedures, specifically for fiberoptic endoscopic evaluation of swallowing with interpretation and report.
CPT code 92613 is used to describe the procedure of conducting an endoscopic evaluation of swallowing function, specifically using fiberoptic endoscopic evaluation of swallowing (FEES) with interpretation and report. This code is utilized by healthcare providers to document and bill for the comprehensive assessment of a patient's swallowing ability, which involves using a flexible endoscope to visualize the swallowing process. The procedure helps in diagnosing swallowing disorders and planning appropriate treatment by providing detailed insights into the mechanics of swallowing and identifying any abnormalities.
For CPT code 92613, which pertains to endoscopy swallow (FEES) interpretation and report, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation and report of the endoscopy swallow study, not the technical component.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the use of equipment and technical staff involved in the procedure, separate from the professional interpretation.
3. Modifier 52 - Reduced Services: This modifier may be used if the procedure was partially reduced or eliminated at the discretion of the provider. It indicates that the service provided was less than usually required.
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. It helps to clarify that the endoscopy swallow study is separate from other procedures.
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. It indicates that the endoscopy swallow study was performed more than once for the same patient 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. It indicates that the endoscopy swallow study was performed more than once for the same patient on the same day by a different provider.
7. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although less common for this type of procedure, this modifier can be used if the test is repeated for clinical reasons on the same day to obtain subsequent results.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines, as modifier usage can vary.
CPT code 92613 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 guidelines set by the Medicare Administrative Contractor (MAC) in your region.
The MPFS provides a list of services and their corresponding reimbursement rates, which are updated annually. However, coverage and reimbursement can vary based on local policies established by the MAC, which administers Medicare claims for specific geographic areas.
Therefore, it is essential for healthcare providers to verify the reimbursement status of CPT code 92613 with their local MAC to ensure compliance with Medicare's billing requirements and to determine the specific reimbursement rate applicable in their area.
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