CPT code 92928 is used for a procedure involving the placement of a stent in a coronary artery with angioplasty on one vessel.
CPT code 92928 is used to describe the procedure of placing a stent in a coronary artery, which is a blood vessel that supplies blood to the heart. This procedure is performed with the assistance of angiography, a type of imaging that helps visualize the blood vessels. The code specifically refers to the placement of a stent in one vessel, which is typically done to open up a narrowed or blocked artery, improving blood flow to the heart and alleviating symptoms such as chest pain. This procedure is commonly used in the treatment of coronary artery disease.
For CPT code 92928, which involves percutaneous coronary intervention with stent placement, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their purposes:
1. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, such as the interpretation of the angiography.
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.
4. Modifier 59 - Distinct Procedural Service: Indicates that a procedure or service was distinct or independent from other services performed on the same day.
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.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Used for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that the procedure is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Similar to Modifier 80, but used when a qualified resident surgeon is not available.
12. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Used when the same laboratory test is repeated on the same day to obtain subsequent test results.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It's important to review the specific payer guidelines as they may have unique requirements for modifier usage.
CPT code 92928 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates. However, the actual reimbursement for CPT code 92928 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national Medicare policies and apply them to their specific jurisdiction, which can influence the reimbursement process for this particular CPT code. Therefore, healthcare providers should consult their local MAC for precise information regarding the reimbursement of CPT code 92928.
Discover the power of MD Clarity's RevFind software to ensure you're receiving every dollar you're owed. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 92928, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and 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
