CPT code 35304 is used for procedures involving the rechanneling of an artery to improve blood flow and restore proper circulation.
CPT code 35304 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 involves techniques such as removing plaque or bypassing the obstructed section of the artery to ensure adequate blood circulation. This code is essential for healthcare providers to accurately document and bill for the specific surgical intervention performed to address arterial blockages.
For CPT code 35304, 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 session.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was carried out.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are actively involved.
5. Modifier 66 - Surgical Team: This modifier is applicable when a surgical team is necessary to perform the procedure, indicating the involvement of multiple professionals.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure on the same day, this modifier is used to denote the repetition.
7. Modifier 77 - Repeat Procedure by Another Physician: If a different physician repeats the procedure on the same day, this modifier is used.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier indicates that the procedure is unrelated to the original surgery and is performed during the postoperative period.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the 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.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can influence the use of modifiers.
CPT code 35304, which pertains to 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 the reimbursement rates for services covered under Medicare Part B. To ascertain if CPT code 35304 is reimbursed, healthcare providers should consult the MPFS to verify its inclusion and the associated payment rate.
Additionally, Medicare Administrative Contractors (MACs) play a pivotal role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that may affect the reimbursement of specific CPT codes. Therefore, it is essential for healthcare providers to check with their respective MAC to ensure that CPT code 35304 is covered and to understand any specific documentation or billing requirements that may apply.
In summary, while CPT code 35304 can be reimbursed by Medicare, providers must verify its status on the MPFS and consult their MAC for any additional guidelines or requirements that could impact reimbursement.
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