CPT code 93565 is used for a specific heart procedure involving selective imaging of the left ventricle or left atrium.
CPT code 93565 is used to describe a specific procedure known as "Selective Left Ventricular/Left Atrial Angiography." This code is utilized when a healthcare provider performs a diagnostic imaging procedure that involves the selective catheterization of the left ventricle or left atrium of the heart. During this procedure, a contrast dye is injected to visualize the heart's structures and assess its function, often to diagnose or evaluate conditions such as heart disease or structural abnormalities. This code is essential for accurate billing and documentation in the context of cardiac catheterization procedures.
For CPT code 93565, which involves selective catheterization for left ventricular or left atrial angiography, 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 the angiography, separate from the technical component.
2. Modifier TC - Technical Component: This modifier is used when the service provided is the technical component, such as the use of equipment and supplies, separate from the professional component.
3. Modifier 59 - Distinct Procedural Service: This modifier may be used if the procedure is distinct or independent from other services performed on the same day. It indicates that the procedure is not normally reported together but is appropriate under the circumstances.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used if 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 if 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 if the patient returns to the operating 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 if the procedure is unrelated to the original procedure and is performed during the postoperative period.
These modifiers help clarify the specific circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 93565 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set by the Medicare Administrative Contractor (MAC) in your region.
The MPFS provides a comprehensive list of services covered by Medicare, along with their respective reimbursement rates. However, coverage can vary based on local policies established by MACs, which are responsible for processing Medicare claims and ensuring compliance with Medicare regulations.
Therefore, to determine if CPT code 93565 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and verify any additional coverage criteria or restrictions imposed by their regional MAC.
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