CPT CODES

CPT Code 92996

CPT code 92996 is used for reporting an additional coronary atherectomy procedure, which involves removing plaque from the arteries.

Table of Contents
What is CPT Code 92996
Does CPT 92996 Need a Modifier?
CPT Code 92996 Medicare Reimbursement
Are You Being Underpaid for 92996 CPT Code?
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What is CPT Code 92996

CPT code 92996 is an add-on code used to describe a coronary atherectomy procedure. This procedure involves the removal of plaque from the coronary arteries to improve blood flow to the heart. It is typically performed in conjunction with other procedures, such as angioplasty or stent placement, to treat coronary artery disease. As an add-on code, 92996 is not billed independently but is used in addition to the primary procedure code to provide a more comprehensive billing for the services rendered during the intervention.

Does CPT 92996 Need a Modifier?

For the CPT code 92996, which pertains to coronary atherectomy as an add-on procedure, 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 a diagnostic test.

2. 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 may be necessary if the atherectomy is performed in a separate session or site from other procedures.

3. 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. It may apply if the atherectomy needs to be performed more than once during the same encounter.

4. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by a different provider. It may be relevant if another physician performs the atherectomy during the same patient encounter.

5. 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 the patient returns to the operating room for a related procedure during the postoperative period.

6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when the procedure is unrelated to the original procedure and is performed during the postoperative period.

7. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although less common for procedural codes, this modifier is used when a test is repeated for clinical reasons. It may apply if diagnostic tests related to the atherectomy are repeated.

These modifiers help clarify the circumstances under which the coronary atherectomy was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.

CPT Code 92996 Medicare Reimbursement

CPT code 92996, which is an add-on code, is reimbursed by Medicare under specific circumstances. The reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries. However, because 92996 is an add-on code, it must be billed in conjunction with a primary procedure code that is also covered by Medicare.

The reimbursement process for CPT code 92996 can also be influenced by the local policies of the Medicare Administrative Contractor (MAC) that services your geographic area. MACs are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that can affect whether and how certain services are reimbursed. Therefore, it is crucial for healthcare providers to consult both the MPFS and their specific MAC's guidelines to ensure compliance and proper reimbursement for CPT code 92996.

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