CPT code 92970 is used for procedures involving cardioassist internal devices, crucial for tracking and managing healthcare services.
CPT code 92970 is used to describe the procedure of inserting a cardioassist device, which is an internal cardiac assist device. This code is specifically utilized when a healthcare provider performs the insertion of a mechanical circulatory support device to aid the heart in pumping blood. Such devices are often used in patients with severe heart failure or during certain cardiac surgeries to ensure adequate blood circulation. The use of this code helps in the accurate billing and documentation of the procedure within the healthcare revenue cycle, ensuring that providers are reimbursed appropriately for the specialized care provided.
For CPT code 92970, which pertains to Cardioassist internal procedures, the following modifiers may be applicable. These modifiers are used to provide additional information about the performed procedure and ensure accurate billing and reimbursement:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for the additional work.
2. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the procedure, not the technical component.
3. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. It indicates that the procedure was not performed in its entirety.
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. It is used to prevent bundling of services that are typically considered part of a single procedure.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
7. 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 requires a return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
9. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required during the procedure. It indicates that another surgeon assisted in the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required for a minimal portion of the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
12. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided. It indicates that multiple modifiers are applicable to the procedure.
Each of these modifiers serves a specific purpose and should be used in accordance with the specific circumstances of the procedure to ensure proper coding and reimbursement. Proper documentation is essential when applying these modifiers to support the necessity and appropriateness of their use.
CPT code 92970 is subject to reimbursement considerations under Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies of 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. However, not all CPT codes are included in the MPFS, and even if they are, the reimbursement can vary based on local coverage determinations made by the MACs.
Therefore, to determine if CPT code 92970 is reimbursed by Medicare, healthcare providers should consult the MPFS for the specific year in question and check with their regional MAC for any additional coverage guidelines or restrictions that may apply.
Discover the power of MD Clarity's RevFind software to ensure you're receiving every dollar you're owed. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 92970, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and maximize your revenue.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
