CPT code 93454 is used for a procedure involving the imaging and study of coronary arteries to assess their condition and function.
CPT code 93454 is used to describe the procedure of coronary artery angiography, which involves the imaging and supervision and interpretation (S&I) of the coronary arteries. This code is specifically utilized when a healthcare provider performs a diagnostic procedure to visualize the coronary arteries using contrast material. The process helps in identifying blockages or other abnormalities within the coronary vessels. The code covers the technical and professional components of the procedure, including the injection of contrast, the use of imaging equipment, and the interpretation of the results by a qualified healthcare professional.
For CPT code 93454, which pertains to coronary artery angiography, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the angiography, not the technical component.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the use of equipment and supplies necessary to perform the angiography, excluding the professional interpretation.
3. 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 multiple procedures are performed that are not typically reported together.
4. 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. It indicates that the procedure was necessary to be performed again.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day. It indicates that the procedure was necessary to be performed again by another provider.
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 when the patient returns to the operating room for a related procedure during the postoperative period of the initial procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although not commonly used with angiography, this modifier may be applicable if the angiography is repeated for clinical reasons on the same day.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. It is important to review the specific circumstances of each case to determine the appropriate use of modifiers.
CPT code 93454 is reimbursed by Medicare, as it is included in 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. However, the reimbursement for CPT code 93454 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). MACs are responsible for processing Medicare claims and have the authority to make coverage decisions and set reimbursement rates within their jurisdictions. Therefore, it is essential for healthcare providers to verify the specific reimbursement details with their local MAC to ensure accurate billing and payment for services associated with CPT code 93454.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments at the CPT code level, including specific codes like 93454. Schedule a demo today to see how RevFind can help you recover lost revenue from individual payers and optimize your financial performance.
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
