CPT code 93580 is for a procedure involving the closure of an atrial septal defect using a catheter-based technique.
CPT code 93580 is used to describe the procedure for the transcatheter closure of an atrial septal defect (ASD). This minimally invasive procedure involves using a catheter to place a closure device in the heart to seal the defect, which is an abnormal opening in the wall (septum) between the two upper chambers of the heart (atria). The procedure is typically performed in a cardiac catheterization lab and is an alternative to open-heart surgery, offering a quicker recovery time for patients.
For CPT code 93580, which pertains to the transcather closure of an atrial septal defect (ASD), the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the professional component of a service is being billed separately from the technical component. It is applicable if the physician is providing only the interpretation of the procedure.
2. 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 distinguished from one another.
3. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician. It is applicable if the transcather closure of ASD needs to be performed more than once on the same day.
4. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician. It is applicable if another physician performs the transcather closure of ASD on the same day.
5. 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 needs to return to the operating room for a related procedure during the postoperative period.
6. 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 of the initial procedure.
7. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure. It indicates that another surgeon assisted in the procedure.
8. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required, and a qualified resident surgeon is not available.
9. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided. It indicates that multiple modifiers are applicable to the procedure.
These modifiers help in accurately coding the procedure and ensuring appropriate reimbursement by reflecting the specific circumstances under which the procedure was performed.
CPT code 93580 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 and their corresponding reimbursement rates, which are updated annually. However, the actual reimbursement for CPT code 93580 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national Medicare policies and establish local coverage determinations (LCDs) that may affect the reimbursement of specific CPT codes. Therefore, healthcare providers should consult their respective MAC for detailed information on the reimbursement criteria and rates applicable to CPT code 93580 in their region.
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