CPT code 35303 is used for procedures involving the rechanneling of an artery, aiding in accurate documentation and reimbursement for healthcare services.
CPT code 35303 is used to describe the surgical procedure of rechanneling an artery. This procedure involves restoring or improving blood flow through an artery that has been narrowed or blocked. It is typically performed to treat conditions such as peripheral artery disease, where plaque buildup restricts blood flow, leading to symptoms like pain or cramping in the limbs. The rechanneling process may involve techniques such as endarterectomy, where the inner lining of the artery is removed, or bypass grafting, where a new pathway is created for blood to flow around the blockage. This code is essential for accurate billing and documentation of the procedure in the healthcare revenue cycle.
For CPT code 35303, which involves the rechanneling of an artery, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the rechanneling procedure is performed on both sides of the body during the same operative session.
2. Modifier 51 - Multiple Procedures: If multiple procedures, including the rechanneling of an artery, are performed during the same surgical session, this modifier indicates that more than one procedure was conducted.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the rechanneling procedure was distinct or independent from other services performed on the same day.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the rechanneling procedure due to its complexity, this modifier indicates that both surgeons are involved in the operation.
5. Modifier 66 - Surgical Team: When a surgical team is necessary to perform the procedure due to its complexity, this modifier is used to denote the involvement of multiple professionals.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the rechanneling procedure on the same day, this modifier is used to indicate the repetition.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a different physician repeats the rechanneling procedure on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: If the patient requires an unplanned return to the operating room for a related procedure during the postoperative period, this modifier is applicable.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when the rechanneling procedure is unrelated to the original procedure performed during the postoperative period.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required to help perform the rechanneling procedure, this modifier is used to indicate their involvement.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
12. 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.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review the specific payer guidelines as they may have unique requirements for modifier usage.
CPT code 35303 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, the actual reimbursement for CPT code 35303 can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) established by the MAC.
These contractors have the authority to interpret Medicare policies and decide on the coverage specifics for procedures within their jurisdiction. Therefore, it is crucial for healthcare providers to consult the MPFS and their respective MAC to confirm the reimbursement status and any specific billing requirements for CPT code 35303.
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