CPT code 92960 is used for the procedure of electric cardioversion, which restores normal heart rhythm by delivering a therapeutic dose of electric current.
CPT code 92960 is used to describe the procedure of electrical cardioversion. This is a medical intervention where an electric shock is delivered to the heart to restore a normal heart rhythm in patients experiencing certain types of abnormal heartbeats, such as atrial fibrillation or atrial flutter. The procedure is typically performed in a hospital or clinical setting under controlled conditions, often with the patient under sedation. The goal of electrical cardioversion is to reset the heart's electrical system, allowing it to resume a regular rhythm. This code is essential for healthcare providers to accurately document and bill for the procedure, ensuring proper reimbursement and maintaining comprehensive patient records.
For CPT code 92960, which pertains to cardioversion electric external, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the service provided is the professional component only, such as the interpretation of the procedure, without the technical component.
2. Modifier TC - Technical Component: This is used when the service provided is the technical component only, such as the use of equipment and supplies, without the professional component.
3. 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. It is used when procedures are not normally reported together but are appropriate under the circumstances.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same provider on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is used when the same procedure is repeated by a different provider on the same day.
6. 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 a patient returns to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when a procedure performed during the postoperative period is unrelated to the original procedure.
These modifiers help clarify the circumstances under which the procedure was performed and ensure accurate billing and reimbursement. It is important to use them appropriately to avoid claim denials or delays.
The CPT code 92960 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, along with the associated payment rates.
However, the actual reimbursement 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 set local coverage determinations, which can influence whether and how a particular service, such as the one associated with CPT code 92960, is reimbursed.
Therefore, healthcare providers should consult their specific MAC for detailed information on coverage and reimbursement for this code.
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