CPT code 92938 is used for reporting additional procedures related to coronary artery bypass grafting, specifically for revascularization.
CPT code 92938 is used to describe an additional procedure involving percutaneous revascularization of a bypass graft. This code is specifically applied when a healthcare provider performs an intervention to restore blood flow through a bypass graft that has become narrowed or blocked. The term "additional" indicates that this code is used in conjunction with another primary procedure, reflecting the complexity and extent of the cardiovascular intervention. This code is crucial for accurate billing and documentation, ensuring that healthcare providers are reimbursed appropriately for the additional work performed during the procedure.
For CPT code 92938, which involves percutaneous revascularization of a bypass graft, additional modifiers may be necessary to provide more specific 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: This modifier is used when only the professional component of the service is being billed, such as the interpretation of diagnostic tests.
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: This modifier is used when multiple procedures are performed during the same session. It helps in identifying that more than one procedure was carried out.
4. Modifier 59 - Distinct Procedural Service: This 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: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is applicable.
6. Modifier 66 - Surgical Team: If the procedure requires a surgical team, this modifier is used to denote that a team of professionals was necessary for the service.
7. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same physician repeats a procedure on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician: This indicates that a procedure was repeated by a different physician on the same day.
9. 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 is used when a patient requires a return to the operating room for a related procedure during the postoperative period.
10. 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.
11. Modifier 80 - Assistant Surgeon: This is used when an assistant surgeon is required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: This indicates that a minimum assistant surgeon was necessary for the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is required because a qualified resident surgeon is not available.
14. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although less common for procedural codes, this modifier is used when a lab test is repeated for clinical reasons.
Each modifier provides additional context that can affect billing and reimbursement, ensuring that the specifics of the procedure are accurately captured and communicated to payers.
CPT code 92938 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in establishing the reimbursement rates for services covered under Medicare Part B, including those associated with CPT codes. However, the actual reimbursement for CPT code 92938 can vary based on geographic location and specific local policies.
Medicare Administrative Contractors (MACs) are responsible for processing claims and making coverage determinations within their respective jurisdictions. They may have specific Local Coverage Determinations (LCDs) that affect whether and how CPT code 92938 is reimbursed. Therefore, healthcare providers should consult the MPFS for the national payment rate and check with their local MAC for any additional guidelines or requirements that might impact reimbursement for this specific CPT code.
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