CPT code 92961 is used for the procedure of electric cardioversion, which restores normal heart rhythm by delivering a therapeutic dose of electric current.
CPT code 92961 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 setting under sedation to ensure patient comfort and safety. The goal of electrical cardioversion is to reset the heart's electrical system, allowing it to resume a regular rhythm and improve the patient's overall cardiac function.
For CPT code 92961, which pertains to cardioversion electric internal, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 26 - Professional Component: This modifier is used when the cardioversion procedure involves only the professional component, such as the interpretation of the results, and not the technical component.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed bilaterally, this modifier indicates that the cardioversion was conducted on both sides.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the cardioversion was a distinct service from other procedures performed on the same day, which are not typically reported together.
4. Modifier 76 - Repeat Procedure by Same Physician: If the cardioversion is repeated on the same day by the same physician, this modifier is used to denote the repeat procedure.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is applicable if the cardioversion is repeated on the same day by a different physician.
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 if the patient needs to return 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: If the cardioversion is unrelated to the original procedure and occurs during the postoperative period, this modifier is appropriate.
8. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the procedure, this modifier is used to indicate the use of multiple modifiers.
Each modifier should be used in accordance with the specific details of the procedure and the payer's guidelines to ensure accurate billing and reimbursement.
CPT code 92961 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 92961 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 setting local coverage determinations, which can influence whether and how much Medicare reimburses for this particular code. Therefore, healthcare providers should consult their specific MAC for detailed information on reimbursement rates and any additional requirements for CPT code 92961.
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