CPT code 35351 is used for procedures involving the rechanneling of an artery to improve blood flow and restore proper circulation.
CPT code 35351 is used to describe the surgical procedure of rechanneling an artery. This involves restoring or improving 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, which is crucial for maintaining adequate circulation and preventing complications related to restricted blood flow. This code is often used in the context of vascular surgery and is an important part of documenting the specific interventions performed to address arterial blockages.
For CPT code 35351, 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 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier indicates that the service was performed bilaterally.
3. Modifier 51 - Multiple Procedures: This is used when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed.
4. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. 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 is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, each surgeon should report their distinct operative work by adding this modifier.
7. Modifier 66 - Surgical Team: This is used when a complex procedure requires the skills of several physicians, often of different specialties, working together as a team.
8. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same physician.
9. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is 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 modifier 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: This is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
12. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: This is used when an assistant surgeon is required for a minimal portion of the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is required because a qualified resident surgeon is not available.
15. Modifier 99 - Multiple Modifiers: This is used 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 provided by the American Medical Association (AMA) and payer-specific policies. Proper documentation is crucial to support the use of any modifier.
CPT code 35351 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 uses to reimburse physicians and other healthcare providers for services rendered. However, the final decision on reimbursement can vary based on local coverage determinations (LCDs) made by the MAC, which may impose specific requirements or limitations on the use of CPT code 35351.
Therefore, it is crucial for healthcare providers to consult the MPFS and their regional MAC to confirm the reimbursement status and any applicable conditions for this particular CPT code.
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