CPT code 93642 is used for an electrophysiology evaluation, a procedure to assess the electrical activity of the heart.
CPT code 93642 is used to describe an electrophysiology evaluation of a patient’s heart. This procedure involves the insertion and positioning of electrode catheters into the heart to record electrical activity and assess the heart's conduction system. It is typically performed to diagnose arrhythmias or other electrical disturbances in the heart. The evaluation helps healthcare providers determine the most effective treatment plan for managing heart rhythm disorders.
For CPT code 93642, which pertains to an electrophysiology evaluation, the following modifiers may be applicable. These modifiers are used to provide additional information about the performed procedure and ensure accurate billing and reimbursement:
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's expertise was utilized in interpreting the results of the electrophysiology evaluation.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It signifies that the facility provided the equipment and technical support necessary for the electrophysiology evaluation.
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 electrophysiology evaluations or related procedures are performed.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same physician performs a repeat procedure on the same day. It indicates that the electrophysiology evaluation was repeated for a valid clinical reason.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a repeat procedure is performed by a different physician on the same day. It helps clarify that the electrophysiology evaluation was necessary and performed 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 if the patient needs to return to the procedure room unexpectedly 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 an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although less common for this type of procedure, this modifier is used when a clinical diagnostic test is repeated for the same patient on the same day to obtain subsequent results.
These modifiers help ensure that the billing accurately reflects the services provided and that reimbursement is processed correctly. It's important for healthcare providers to use these modifiers appropriately to avoid claim denials or delays.
CPT code 93642 is subject to reimbursement by Medicare, but its reimbursement status depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) in your region.
The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates. However, the final determination of whether CPT code 93642 is reimbursed can vary based on local coverage determinations (LCDs) and other policies established by the MAC responsible for your geographic area.
It is crucial for healthcare providers to verify the specific coverage details and reimbursement rates for CPT code 93642 by consulting the MPFS and the relevant MAC's guidelines to ensure compliance and accurate billing.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including CPT code 93642, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and maximize your financial outcomes.
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
