CPT code 35306 is used for the procedure involving the rechanneling of an artery, which is essential for accurate medical procedure documentation.
CPT code 35306 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, which is the removal of plaque from the arterial wall, or other methods to clear the obstruction and ensure proper circulation. This code is crucial for healthcare providers to accurately document and bill for the specific surgical intervention performed to address arterial blockages.
When considering the use of modifiers for CPT code 35306, which involves the rechanneling of an artery, it's important to understand the context and specifics of the procedure to determine the appropriate modifiers. Here is a list of potential modifiers that could be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required. This could be due to unusual anatomy or complications that arose during the procedure.
2. Modifier 50 - Bilateral Procedure: If the rechanneling of arteries was performed on both sides of the body during the same session, this modifier would be appropriate.
3. Modifier 51 - Multiple Procedures: This is used when multiple procedures are performed during the same surgical session. If the rechanneling is part of a series of procedures, this modifier may be applicable.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It might be used if the rechanneling was performed in a separate session or on a different site than other procedures.
5. Modifier 62 - Two Surgeons: If two surgeons were required to perform the procedure due to its complexity, this modifier would be appropriate.
6. Modifier 66 - Surgical Team: This modifier is used when a team of surgeons is necessary to perform the procedure, indicating the complexity and need for specialized skills.
7. Modifier 76 - Repeat Procedure by Same Physician: If the procedure needed to be repeated by the same physician, this modifier would be used.
8. Modifier 77 - Repeat Procedure by Another Physician: If the procedure was repeated by a different physician, this modifier would be applicable.
9. 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 had to return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If an unrelated procedure was performed during the postoperative period, this modifier would be used.
11. Modifier 80 - Assistant Surgeon: If an assistant surgeon was necessary for the procedure, this modifier would be appropriate.
12. Modifier 81 - Minimum Assistant Surgeon: This is used when a minimal assistant surgeon was required for the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required due to the unavailability of a qualified resident.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when these professionals assist in the surgery.
The use of these modifiers depends on the specific circumstances of the procedure and should be carefully considered to ensure accurate billing and reimbursement.
CPT code 35306, 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 by physicians and other healthcare professionals under Medicare Part B.
However, it's important to note that the reimbursement for CPT code 35306 can also vary based on the policies of the local Medicare Administrative Contractor (MAC). MACs are private organizations that have been contracted by Medicare to process claims and determine coverage at a regional level. They have the authority to make decisions on the medical necessity and appropriateness of services, which can influence whether a particular service is reimbursed.
Therefore, while CPT code 35306 is listed in the MPFS, healthcare providers should verify with their specific MAC to ensure that the service meets the necessary criteria for reimbursement in their region. This includes checking for any local coverage determinations (LCDs) or national coverage determinations (NCDs) that might affect the reimbursement status of this procedure.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 35306. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
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