CPT code 92997 is used for describing a procedure involving the repair of a pulmonary artery using a balloon through a minimally invasive technique.
CPT code 92997 is used to describe a percutaneous balloon repair of a pulmonary artery. This procedure involves the use of a balloon catheter to repair or dilate a narrowed or obstructed pulmonary artery, which is one of the major blood vessels that carries blood from the heart to the lungs. The term "percutaneous" indicates that the procedure is minimally invasive, typically performed through a small incision or puncture in the skin, allowing for quicker recovery times compared to traditional open surgery. This code is crucial for accurately documenting and billing this specific cardiovascular intervention in the healthcare revenue cycle.
For CPT code 92997, which pertains to pulmonary artery balloon repair performed percutaneously, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the service provided is the professional component, such as the interpretation of a diagnostic test, separate from the technical component.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier indicates that the service was bilateral.
3. Modifier 51 - Multiple Procedures: This is used when multiple procedures are performed during the same session. It indicates that the procedure is one of several performed.
4. Modifier 52 - Reduced Services: This modifier is applied when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: This is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This is used when the same procedure is repeated by a different physician on the same day.
8. 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 returns 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 indicates that the procedure is unrelated to the original procedure and is performed during the postoperative period.
10. Modifier 80 - Assistant Surgeon: This is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimal assistant surgeon is required.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
13. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although less common for this type of procedure, this modifier is used when a laboratory test is repeated for the same patient on the same day to obtain subsequent test results.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 92997 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. Whether CPT code 92997 is reimbursed by Medicare depends on several factors, including its inclusion in the MPFS and any specific guidelines or coverage determinations made by the Medicare Administrative Contractor (MAC) for the region in which the service is provided.
MACs are responsible for processing Medicare claims and have the authority to make local coverage determinations (LCDs) that can affect the reimbursement of specific CPT codes. Therefore, while CPT code 92997 may be listed in the MPFS, its reimbursement is contingent upon the policies and guidelines established by the relevant MAC. Providers should consult the MPFS and their local MAC's policies to determine the specific reimbursement status of CPT code 92997 in their area.
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