CPT code 35311 is used for procedures involving the rechanneling of an artery to improve blood flow and restore proper circulation.
CPT code 35311 is used to describe a surgical procedure known as the rechanneling of an artery. This procedure involves the restoration or improvement of blood flow through an artery that has become 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 removing the blockage, widening the artery, or creating a new pathway for blood flow, ultimately aiming to enhance circulation and alleviate symptoms associated with reduced blood supply.
For CPT code 35311, which involves the rechanneling of an artery, the following modifiers may be applicable depending on the specific circumstances of the procedure and the billing requirements:
1. Modifier 50 - Bilateral Procedure: Used when the procedure is performed on both sides of the body during the same operative session.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
3. Modifier 52 - Reduced Services: Utilized when the procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 59 - Distinct Procedural Service: Indicates that the procedure is distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. Modifier 62 - Two Surgeons: Applied when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
6. Modifier 66 - Surgical Team: Used when a complex procedure requires the skills of several physicians, often from different specialties, working together as a team.
7. Modifier 76 - Repeat Procedure by Same Physician: Indicates that the procedure was repeated by the same physician subsequent to the original procedure.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure is repeated by a different physician than the one who originally performed it.
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: Indicates a 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: Used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
11. Modifier 80 - Assistant Surgeon: Applied when an assistant surgeon is required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon is required for a portion of the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these non-physician practitioners assist in the surgery.
Each modifier serves a specific purpose and should be used in accordance with payer guidelines and the specific circumstances of the procedure. Proper use of modifiers ensures accurate billing and reimbursement.
CPT code 35311 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 policies set by the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a comprehensive list of services covered by Medicare and assigns relative value units (RVUs) to each service, which are used to calculate reimbursement rates.
However, the final decision on whether CPT code 35311 is reimbursed can also depend on local coverage determinations (LCDs) made by the MAC.
These contractors have the authority to establish specific guidelines and criteria for coverage based on regional needs and medical necessity.
Therefore, it is essential for healthcare providers to consult the MPFS and their respective MAC's policies to confirm the reimbursement status of CPT code 35311.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including specific codes like 35311. Schedule a demo today to see how RevFind can help you maximize your reimbursements and streamline your financial operations.
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