CPT code 35355 is used for the procedure involving the rechanneling of an artery, which helps in restoring proper blood flow.
CPT code 35355 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, or creating a new channel for blood flow. This code is utilized by healthcare providers to accurately document and bill for the specific service of rechanneling an artery, ensuring proper reimbursement and record-keeping within the healthcare revenue cycle.
For CPT code 35355, which involves the rechanneling of an artery, the following modifiers may be applicable. These modifiers are used to provide additional information about the procedure performed and to ensure accurate billing and reimbursement:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the rechanneling procedure is performed on both sides of the body during the same operative session.
2. Modifier 51 - Multiple Procedures: If the rechanneling of the artery is performed in conjunction with other procedures during the same surgical session, this modifier indicates that multiple procedures were performed.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the rechanneling procedure was 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 involved and should be reimbursed accordingly.
5. Modifier 66 - Surgical Team: When the procedure requires a surgical team due to its complexity, this modifier is used to indicate that multiple professionals were involved in the surgery.
6. Modifier 76 - Repeat Procedure by Same Physician: If the rechanneling procedure needs to be repeated by the same physician, this modifier is used to indicate that the procedure was performed more than once on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the rechanneling procedure is repeated by a different physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: If the patient needs to return to the operating room for a related procedure during the postoperative period, this modifier is used.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when the rechanneling procedure is performed during the postoperative period of another surgery but is unrelated to the initial procedure.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required to help perform the rechanneling procedure, this modifier indicates their involvement.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
These modifiers help clarify the circumstances under which the procedure was performed and ensure that healthcare providers receive appropriate reimbursement for their services. Proper use of modifiers is crucial in healthcare revenue cycle management to avoid claim denials and ensure compliance with payer requirements.
CPT code 35355, which pertains to 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 to Medicare beneficiaries and is updated annually to reflect changes in policy and practice.
To ascertain if CPT code 35355 is reimbursed, healthcare providers should consult the MPFS to verify its inclusion and the associated reimbursement rate. Additionally, Medicare Administrative Contractors (MACs) play a pivotal role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make determinations on coverage and payment for services within their jurisdictions. They may have specific local coverage determinations (LCDs) that affect whether CPT code 35355 is reimbursed.
Therefore, while CPT code 35355 may be listed in the MPFS, providers should also check with their respective MACs to ensure compliance with any local policies or requirements that could impact reimbursement.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments at the CPT code level, including CPT code 35355, and by individual payer. Schedule a demo today to see how RevFind can help you maximize your reimbursements and streamline your financial operations.
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