CPT code 92937 is used for reporting a procedure involving the revascularization of a bypass graft in one vessel.
CPT code 92937 is used to describe a percutaneous revascularization procedure involving a bypass graft for one vessel. This code is typically utilized when a healthcare provider performs an intervention to restore adequate blood flow through a previously established bypass graft, addressing issues such as blockages or narrowing that may have developed over time. The procedure is minimally invasive, often involving techniques like angioplasty or stenting to improve circulation and ensure the graft functions effectively. This code is crucial for accurate billing and documentation in the context of cardiovascular care.
For CPT code 92937, which involves percutaneous revascularization of a bypass graft for one vessel, 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, typically when the procedure involves both a technical and professional component.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier indicates that the service was bilateral.
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: This modifier is 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: This modifier is used when a patient requires an unplanned 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: This modifier is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
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 commonly used with surgical procedures, 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. It is important to use the appropriate modifiers to avoid claim denials and ensure compliance with payer requirements.
The CPT code 92937 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. Each MAC may have specific local coverage determinations (LCDs) that can affect whether a particular service, such as the one associated with CPT code 92937, is reimbursed.
Therefore, it is essential for healthcare providers to verify the reimbursement status of CPT code 92937 with their respective MAC to ensure compliance with regional policies and to understand any documentation requirements that may influence reimbursement.
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