CPT code 35305 is used for the procedure involving the rechanneling of an artery to improve blood flow and restore proper circulation.
CPT code 35305 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 become narrowed or blocked. The procedure typically involves techniques such as removing plaque or other obstructions from the artery to ensure that blood can flow more freely, thereby improving circulation and reducing the risk of complications associated with restricted blood flow. This code is essential for accurately documenting and billing for the surgical intervention aimed at addressing arterial blockages.
For CPT code 35305, which pertains to 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 the rechanneling of the artery is performed in conjunction with other procedures during the same operative session, this modifier may be applied to indicate multiple procedures.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the rechanneling 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 rechanneling procedure due to its complexity, this modifier indicates that both surgeons are actively involved.
5. Modifier 76 - Repeat Procedure by Same Physician: If the rechanneling procedure needs to be repeated by the same physician on the same day, this modifier is used.
6. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician on the same day, this modifier is applicable.
7. 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 operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If the rechanneling procedure is performed during the postoperative period of another procedure but is unrelated, this modifier is used.
9. Modifier 80 - Assistant Surgeon: If an assistant surgeon is necessary for the procedure, this modifier indicates their involvement.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Similar to Modifier 80, but specifically used when a qualified resident surgeon is not available.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is crucial to review the specific payer policies and guidelines, as they may have unique requirements for modifier usage.
CPT code 35305 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 will pay for each service, and it is updated annually to reflect changes in policy and practice costs.
Additionally, MACs, which are private health care insurers contracted by Medicare, have the authority to make local coverage determinations (LCDs) that can affect whether a particular CPT code, such as 35305, is reimbursed.
Therefore, it is essential for healthcare providers to consult both the MPFS and their regional MAC's policies to determine the exact reimbursement status and any specific requirements or documentation needed for CPT code 35305.
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