CPT code 92975 is used for procedures involving the dissolution of a clot in a heart vessel, aiding in restoring normal blood flow.
CPT code 92975 is used to describe a medical procedure known as "thrombectomy," which involves the removal or dissolution of a blood clot from a heart vessel. This procedure is typically performed to restore normal blood flow in cases where a clot is obstructing a coronary artery, which can lead to serious conditions such as a heart attack. The code is utilized by healthcare providers to accurately document and bill for this specific intervention, ensuring that the procedure is recognized and reimbursed appropriately by insurance companies.
For CPT code 92975, which involves the procedure to dissolve a clot in a heart vessel, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the procedure involves both a professional and technical component, and you are billing only for the professional component.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the heart, this modifier indicates that it was a bilateral procedure.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: If the procedure needs to be repeated by the same physician on the same day, this modifier is applicable.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the procedure is repeated by a different physician 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 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: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period.
8. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier is used to indicate their involvement.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although less common for this type of procedure, if a diagnostic test related to the procedure needs to be repeated, this modifier can be used.
Each of these modifiers serves a specific purpose and should be applied based on the specific circumstances surrounding the procedure to ensure accurate billing and reimbursement.
CPT code 92975, which involves a specific medical procedure, is subject to reimbursement considerations under Medicare. To determine if this code is reimbursed by Medicare, one must refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with their respective reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific guidance on whether CPT code 92975 is reimbursed. They may have Local Coverage Determinations (LCDs) that affect the reimbursement status of certain procedures, including 92975.
Therefore, healthcare providers should consult the MPFS and their respective MACs to confirm the reimbursement status of CPT code 92975 under Medicare.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 92975, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize your revenue cycle management.
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
