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92978
Quick jump to procedure code: Printer Friendly Version
92986

CPT® 92979: INTRAVASCULAR ULTRASOUND (CORONARY VESSEL OR GRAFT) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION INCLUDING IMAGING SUPERVISION, INTERPRETATION AND REPORT; EACH ADDITIONAL VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Short Description: Intravasc us heart add-on

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

26 Modifier $ 79.54
TC Modifier $ 0.00
Revenue Code(s):
481-Cardiology-cardiac cath lab



2016 OPPS Status Indicator: N

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
PercentageICD-9ICD-10 Conversions
34.6% 414.01    Coronary atherosclerosis of native coronary artery I25.10   Atherosclerotic heart disease of native coronary artery without angina pectoris
7.3% 411.1    Intermediate coronary syndrome I20.0   Unstable angina
3.8% 413.9    Other and unspecified angina pectoris I20.8   Other forms of angina pectoris
OR:
I20.9   Angina pectoris, unspecified
3.5% 794.30    Abnormal function study, unspecified R94.30   Abnormal result of cardiovascular function study, unspecified
2.9% 794.39    Other abnormal results of function studies R94.39   Abnormal result of other cardiovascular function study
2.3% 401.1    Benign hypertension I10   Essential (primary) hypertension
2.1% 786.50    Chest pain, unspecified R07.9   Chest pain, unspecified
1.8% 272.2    Mixed hyperlipidemia E78.2   Mixed hyperlipidemia
1.8% 410.71    Subendocardial infarction, initial episode of care I21.4   Non-ST elevation (NSTEMI) myocardial infarction
1.8% 427.31    Atrial fibrillation I48.91   Unspecified atrial fibrillation

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

92979 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 92979

CCI and MUE Edits*         Hide this section.

CCI Edits for 92979
Denied Codes (1)
Effective
Modifier
Accepted (2)
0205T Inirs each vessel add-on
07/01/2011 Yes
36500 Insertion of catheter vein
10/01/2006 Yes
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
75893 Venous sampling by catheter
10/01/2006 Yes
93000 Electrocardiogram complete
07/01/2008 Yes
93005 Electrocardiogram tracing
07/01/2008 Yes
93010 Electrocardiogram report
07/01/2008 Yes
93040 Rhythm ecg with report
07/01/2008 Yes
93041 Rhythm ecg tracing
07/01/2008 Yes
93042 Rhythm ecg report
07/01/2008 Yes
93050 Art pressure waveform analys
01/01/2016 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
94770 Exhaled carbon dioxide test
07/01/2008 Yes
99143 Mod sedat phys/qhp <5 yrs
04/01/2006 No
99144 Mod sedat phys/qhp 5yrs/>
04/01/2006 No
99145 Mod sedat phys/qhp ea 15 min
10/01/2009 No
99148 Mod sed diff phys/qhp<5 yrs
10/01/2008 No
99149 Mod sed diff phys/qhp 5/>yrs
10/01/2008 No
99150 Mod sed diff phys/qhp add on
10/01/2009 No
99446 Interprof phone/online 5-10
01/01/2014 No
99447 Interprof phone/online 11-20
01/01/2014 No
99448 Interprof phone/online 21-30
01/01/2014 No
99449 Interprof phone/online 31/>
01/01/2014 No
(1) These codes will be denied when submitted for payment on the same date of service as 92979.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 92979


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 2 2 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Clinical: Data Clinical: Data Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   92979 Top 5 Ordering Providers National*
BRENT MCLAURIN -ANDERSON,SC 189
CHARLES CROFT -MELBOURNE,FL 142
JACK CASAS -MUSKOGEE,OK 108
JOSEPH CALIFANO -NAPLES,FL 86
JOSEPH DEGREGORIO -GLEN RIDGE,NJ 71

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 92979*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2015: 6,606
Total Services Denied 2015: 1,030 (15.6%)
National Charges Submitted 2015: $ 1,696,505.00
National Charges Allowed 2015: $ 453,868.00
National Average (No Modifier) Fee Submitted 2015: $271.50
National Average (No Modifier) Fee Allowed 2015: $150.67
National Average (26) Fee Submitted 2015: $254.64
National Average (26) Fee Allowed 2015: $ 81.22


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Cardiology 4,500 68.1% $261.30 736 16.4%
Internal medicine 241 3.6% $258.84 36 14.9%
Unknown physician specialty 57 0.9% $332.93 9 15.8%
Cardiac surgery
(eff 5/92)
43 0.7% $156.01 5 11.6%
Pathologic anatomy, clinical pathology
(osteopaths only)
(discontinued 5/92 use code 22)
16 0.2% $173.96 2 12.5%

Top 5 Places of Service 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Inpatient hospital 3,344 50.6% $251.55 562 16.8%
Outpatient hospital 3,234 49.0% $262.35 450 13.9%
Office 13 0.2% $204.59 8 61.5%
Emergency room - hospital 11 0.2% $306.45 8 72.7%
Ambulatory surgical center 2 0.0% $215.00 2 100.0%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
26 - Professional Component 6,411 97.0% $254.66 846 13.2%
59 - Distinct Procedural Service 49 0.7% $232.24 48 98.0%
No Modifier 38 0.6% $271.54 35 92.1%
LC 34 0.5% $391.84 33 97.1%
LM 31 0.5% $275.03 29 93.5%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

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08/28/2016 11:35:24 54.198.229.157

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