CPT code 92998 is used for a procedure involving the repair of a pulmonary artery using a balloon technique performed through the skin.
CPT code 92998 is used to describe a percutaneous procedure involving the repair of a pulmonary artery using a balloon. This code is typically utilized in the context of interventional cardiology, where a catheter with a balloon at its tip is inserted through the skin and navigated to the pulmonary artery. Once in place, the balloon is inflated to help repair or open up the artery, improving blood flow. This procedure is often performed to address conditions such as pulmonary artery stenosis, where the artery is narrowed, potentially impacting the patient's cardiovascular health.
For CPT code 92998, which pertains to pulmonary artery balloon procedures performed percutaneously, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the professional component of the 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 procedure is performed on both sides of the body, this modifier indicates that the service was bilateral.
3. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same session. It helps in identifying that more than one procedure was conducted.
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 applicable when procedures are not typically reported together but are appropriate under the circumstances.
5. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician, this modifier is used to indicate that the procedure was repeated.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the procedure is repeated by a different physician.
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 if there is an unplanned 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 an unrelated procedure is performed by the same physician during the postoperative period.
9. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
10. 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.
11. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided.
These modifiers help in providing additional information about the procedure performed and ensure accurate billing and reimbursement. It is important to use them appropriately to avoid claim denials or delays.
CPT code 92998 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by 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, the final decision on whether CPT code 92998 is reimbursed can vary based on local coverage determinations (LCDs) made by the MAC.
These contractors have the authority to interpret national policies and establish specific guidelines for coverage in their jurisdiction. Therefore, it is crucial for healthcare providers to consult the MPFS and their respective MAC to confirm the reimbursement status of CPT code 92998.
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