CPT code 92934 is used for procedures involving the placement of a stent, atherectomy, and angioplasty in coronary arteries.
CPT code 92934 is used to describe a percutaneous coronary intervention (PCI) procedure that involves the placement of a stent, along with atherectomy and angioplasty, in a coronary artery. This code is specifically utilized when a healthcare provider performs a combination of these procedures to open up a narrowed or blocked coronary artery, which is crucial for restoring adequate blood flow to the heart muscle. The use of a stent helps to keep the artery open after the procedure, while atherectomy involves removing plaque from the artery, and angioplasty refers to the use of a balloon to widen the artery. This comprehensive approach is often necessary for patients with complex coronary artery disease.
For CPT code 92934, which involves percutaneous coronary interventions, 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 physician's services are separate from the technical component.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier is used to indicate that it was a bilateral procedure.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same session, this modifier is used to indicate that more than one procedure was conducted.
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 62 - Two Surgeons: If two surgeons are required to perform the procedure, this modifier indicates that both surgeons were necessary for the completion of the procedure.
6. 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.
7. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician on the same day, this modifier is used.
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 the patient returns 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 an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help perform the procedure.
11. 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.
12. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although not typically used for procedures like 92934, this modifier is used when a clinical diagnostic test is repeated for the same patient 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 they may have unique requirements for modifier usage.
CPT code 92934 is reimbursed by Medicare, but its 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 and the corresponding payment rates. However, the actual reimbursement for CPT code 92934 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and providing guidance on coverage and reimbursement policies within their jurisdiction. Therefore, healthcare providers should consult their local MAC for detailed information on the reimbursement criteria and any potential limitations or requirements associated with CPT code 92934.
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