CPT code 93564 is used for a procedure involving selective opacification during a cardiac catheterization.
CPT code 93564 is used to describe a procedure involving the selective opacification of a coronary artery during a cardiac catheterization. This code specifically refers to the injection of contrast material into a coronary artery to visualize its structure and function, which is a critical component in diagnosing and assessing coronary artery disease. The procedure is typically performed by a cardiologist and is essential for planning further interventions or treatments based on the findings.
For CPT code 93564, which involves a specific cardiac catheterization procedure, 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 provider is billing for the interpretation of the procedure, 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 equipment, supplies, and technical support, 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 is used when procedures are not normally reported together but are appropriate under the circumstances.
4. 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 on the same day.
5. 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 on the same day.
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 related procedure is performed 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 an unrelated procedure is performed by the same provider during the postoperative period of a different procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It's important to use them correctly to avoid claim denials or delays.
CPT code 93564 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 policies 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 93564 is reimbursed can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) established by the MAC.
It is essential for healthcare providers to verify the specific guidelines and reimbursement rates applicable to their location by consulting the MAC responsible for their jurisdiction. This ensures compliance with Medicare's billing requirements and maximizes the likelihood of appropriate reimbursement.
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