CPT code 92995 is used for coronary atherectomy, a procedure to remove plaque from arteries to improve blood flow to the heart.
CPT code 92995 is used to describe a coronary atherectomy procedure. This procedure involves the removal of atherosclerotic plaque from the coronary arteries, which are the blood vessels that supply blood to the heart muscle. The goal of a coronary atherectomy is to improve blood flow to the heart by clearing blockages that can lead to conditions such as angina or heart attacks. This code is typically used by healthcare providers to document and bill for the procedure when performed as part of a patient's treatment plan.
For the CPT code 92995, which pertains to coronary atherectomy, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the professional component of a service is being billed separately from the technical component. It is applicable if the physician is only providing the interpretation of the procedure.
2. Modifier 50 - Bilateral Procedure: If the coronary atherectomy is performed on both sides of the coronary arteries during the same session, this modifier is used to indicate a bilateral procedure.
3. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It helps in identifying that more than one procedure was performed.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It is applicable when the atherectomy is performed in a different session or site.
5. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier is used to indicate that both surgeons are involved in the procedure.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same physician performs the procedure more than once on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a different physician performs the procedure more than once on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure is performed by the same physician during the postoperative period of another procedure, but it is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help with the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
These modifiers help in providing additional information about the circumstances under which the coronary atherectomy was performed, ensuring accurate billing and reimbursement.
CPT code 92995 is associated with coronary atherectomy procedures. To determine if this code is reimbursed by Medicare, one must consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the Medicare Administrative Contractor (MAC) specific to the region where the service is rendered. The MPFS outlines the payment rates for services covered under Medicare Part B, and it is updated annually to reflect changes in reimbursement policies. Additionally, MACs, which are private organizations contracted by Medicare, have the authority to interpret national policies and make local coverage determinations that can affect reimbursement. Therefore, while CPT code 92995 may be listed in the MPFS, its reimbursement is contingent upon the MAC's local coverage decisions and any specific billing requirements they may impose. Healthcare providers should verify the latest MPFS and consult their regional MAC to ensure compliance and confirm reimbursement eligibility for CPT code 92995.
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 92995, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and optimize your financial outcomes.
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
