CPT code 35302 is used for procedures involving the rechanneling of an artery, aiding in accurate documentation and reimbursement for healthcare services.
CPT code 35302 is used to describe the surgical procedure of rechanneling an artery. This involves the restoration or improvement of blood flow through an artery that has been narrowed or blocked. The procedure typically includes techniques such as endarterectomy, where plaque is removed from the artery, or bypass grafting, where a new pathway is created for blood flow. This code is essential for accurately documenting and billing for the surgical intervention aimed at treating conditions like peripheral artery disease, ensuring that healthcare providers are reimbursed appropriately for their services.
For CPT code 35302, which pertains to the rechanneling of an artery, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier should be used to indicate that the procedure was bilateral.
3. Modifier 51 - Multiple Procedures: Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed.
4. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures that are not normally reported together but are appropriate under the circumstances.
6. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure, this modifier indicates that each surgeon performs a distinct part of the procedure.
7. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the skills of a surgical team.
8. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure needs to be repeated by the same physician after the initial procedure.
9. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated by a different physician.
10. 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 patient requires a return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier for procedures performed by the same physician during the postoperative period that are unrelated to the original procedure.
12. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Use this modifier when a minimum assistant surgeon is required.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician practitioner assists in the surgery.
Each modifier serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper documentation is crucial to support the use of any modifier.
CPT code 35302, which involves the rechanneling of an artery, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines whether a specific CPT code is reimbursable and at what rate. The MPFS outlines the payment rates for services provided to Medicare beneficiaries, and CPT code 35302 would be listed there if it is covered.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make coverage decisions based on local coverage determinations (LCDs). These contractors may have specific guidelines or requirements that must be met for CPT code 35302 to be reimbursed. Therefore, healthcare providers should consult both the MPFS and their respective MACs to confirm the reimbursement status and any specific conditions that may apply to CPT code 35302.
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