CPT code 93455 is used for coronary artery and graft angiography, including supervision and interpretation of the procedure.
CPT code 93455 is used to describe a specific medical procedure known as coronary artery and graft angiography with imaging supervision and interpretation. This code is utilized when a healthcare provider performs a diagnostic procedure to visualize the coronary arteries and any grafts that may have been placed during previous surgeries. The process involves the injection of a contrast dye into the coronary arteries, allowing the physician to assess the blood flow and identify any blockages or abnormalities. The imaging supervision and interpretation component indicates that the healthcare provider is responsible for overseeing the imaging process and interpreting the results to make informed clinical decisions. This code is crucial for accurate billing and documentation in the context of cardiovascular diagnostics.
For CPT code 93455, which involves coronary artery and graft angiography with supervision and interpretation, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. It indicates that the physician provided only the interpretation and report of the angiography.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It indicates that the facility provided the equipment, supplies, and technical staff necessary for the procedure.
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 and need to be reported separately.
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 and not a duplicate billing error.
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 helps differentiate between services provided by different practitioners.
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 a patient requires an unplanned return to the procedure room for a related procedure during the postoperative period.
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 the two are unrelated.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. It is important to use them appropriately to avoid claim denials or delays.
CPT code 93455 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates. However, the actual reimbursement for CPT code 93455 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting payment policies within their jurisdiction, which means they may have additional requirements or documentation needed for reimbursement. Healthcare providers should consult their local MAC for precise details on coverage and reimbursement rates for CPT code 93455.
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