CPT code 92924 is used for reporting a procedure involving coronary artery angioplasty with atherectomy on one artery.
CPT code 92924 is used to describe a percutaneous coronary intervention (PCI) procedure that involves both angioplasty and atherectomy on a single coronary artery. This code is specifically utilized when a healthcare provider performs a balloon angioplasty to open up a narrowed or blocked coronary artery and also uses an atherectomy device to remove plaque from the artery wall. This dual approach is often employed to improve blood flow to the heart muscle, especially in cases where the plaque is particularly hard or calcified, making it difficult to treat with angioplasty alone. This procedure is typically performed in a cardiac catheterization lab and is crucial for patients with coronary artery disease to alleviate symptoms such as chest pain and to reduce the risk of heart attacks.
When dealing with CPT code 92924, which involves percutaneous coronary interventions, certain modifiers may be necessary to provide additional information about the procedure performed. Here is a list of potential modifiers that could be used with this code, along with the reasons for their use:
1. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, typically by the physician performing the procedure.
2. Modifier 50 - Bilateral Procedure: Applied if the procedure is performed on both sides of the body during the same session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
4. Modifier 59 - Distinct Procedural Service: Indicates that the procedure is distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
6. Modifier 76 - Repeat Procedure by Same Physician: Applied when the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same 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: Indicates 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 91 - Repeat Clinical Diagnostic Laboratory Test: Although not typically used with surgical procedures, this modifier is included for completeness as it applies to repeat laboratory tests.
These modifiers help clarify the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is crucial to select the appropriate modifier to avoid claim denials and ensure compliance with payer policies.
CPT code 92924 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services and procedures covered by Medicare, and CPT code 92924 is listed with an assigned reimbursement rate. However, it's important to note that reimbursement can vary based on geographic location and other factors, as determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a specific region. Each MAC may have specific guidelines and policies that can affect the reimbursement process for CPT code 92924. Therefore, healthcare providers should verify the specific reimbursement details with their local MAC to ensure compliance and accurate billing.
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