CPT code 35361 is used for procedures involving the rechanneling of an artery to improve blood flow and restore proper circulation.
CPT code 35361 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. The rechanneling process typically involves techniques such as removing plaque or other obstructions, widening the artery, or creating a new pathway for blood flow. This code is essential for healthcare providers to accurately document and bill for the surgical intervention aimed at addressing arterial blockages, which can be critical for maintaining proper circulation and preventing complications such as tissue damage or organ dysfunction.
For CPT code 35361, which involves the rechanneling of an artery, the following modifiers may be applicable depending on the specific circumstances of the procedure:
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 multiple procedures are performed during the same surgical session, this modifier indicates that the rechanneling of the artery is one of several procedures.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the rechanneling procedure is distinct or independent from other services performed on the same day.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are involved in the rechanneling of the artery.
5. Modifier 66 - Surgical Team: This modifier is applicable if the procedure requires a surgical team due to its complexity or the patient's condition.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the rechanneling procedure on the same day, this modifier is used.
7. Modifier 77 - Repeat Procedure by Another Physician: If another physician repeats the procedure on the same day, this modifier is applicable.
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: This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If the rechanneling procedure is unrelated to the initial surgery and occurs during the postoperative period, this modifier is used.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier indicates their involvement.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimal assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): If a qualified resident surgeon is not available, this modifier indicates the need for an assistant surgeon.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician practitioner assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review the specific payer guidelines and documentation requirements when applying these modifiers.
CPT code 35361 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 will pay for each service, and it is updated annually to reflect changes in medical practice and economic conditions.
To determine if CPT code 35361 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the associated reimbursement rate. Additionally, since MACs have the authority to interpret national policies and make local coverage decisions, it is crucial to check with the MAC that administers Medicare claims in your area. They may have specific guidelines or requirements that affect the reimbursement of this particular code. Therefore, while CPT code 35361 can be reimbursed by Medicare, the actual payment and coverage details will depend on these regulatory frameworks and local determinations.
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