CPT code 35321 is used for procedures involving the rechanneling of an artery to improve blood flow and restore proper circulation.
CPT code 35321 is used to describe a surgical procedure known as the rechanneling of an artery. This procedure involves the restoration or improvement of blood flow in an artery that has become narrowed or blocked. It typically involves techniques such as endarterectomy, where plaque or blockages are removed from the artery, or bypass grafting, where a new pathway is created for blood to flow around the obstruction. This code is essential for accurately documenting and billing for the surgical intervention aimed at addressing arterial blockages, which can be critical for preventing complications such as ischemia or tissue damage.
For CPT code 35321, which involves the rechanneling of an artery, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their reasons for use:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 50 - Bilateral Procedure: Applied if the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
4. Modifier 52 - Reduced Services: Utilized when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
6. Modifier 62 - Two Surgeons: Applied when two surgeons work together as primary surgeons performing distinct parts of a procedure.
7. Modifier 66 - Surgical Team: Used when a complex procedure requires the services of a surgical team.
8. Modifier 76 - Repeat Procedure by Same Physician: Indicates that the same procedure was repeated by the same physician subsequent to the original procedure.
9. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure is repeated by a different physician.
10. 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 is used when a patient requires a return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that a procedure performed during the postoperative period was unrelated to the original procedure.
12. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required for the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
15. Modifier 99 - Multiple Modifiers: Applied when two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines set forth by the American Medical Association and payer policies to ensure accurate billing and reimbursement.
CPT code 35321 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that outlines the payment rates for services covered under Medicare Part B, including surgical procedures like those represented by CPT code 35321. To determine if this specific code is reimbursed, healthcare providers should consult the MPFS to verify if the procedure is listed and the associated reimbursement rate.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make local coverage determinations (LCDs) that can affect whether a particular service is reimbursed in their jurisdiction. Therefore, it is essential for healthcare providers to check with their respective MAC to ensure that CPT code 35321 is covered and to understand any specific documentation or billing requirements that may apply.
In summary, while CPT code 35321 can be reimbursed by Medicare, providers must verify its inclusion in the MPFS and consult their MAC for any local coverage policies that might impact reimbursement.
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