CPT code 35363 is used for the procedure involving the rechanneling of an artery, helping healthcare providers document and categorize medical services.
CPT code 35363 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, or creating a new pathway for blood flow, to ensure that the artery can effectively deliver blood to the necessary tissues. This code is utilized by healthcare providers to accurately document and bill for the specific service provided during the revascularization process.
When dealing with CPT code 35363, which pertains to 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 that could be used:
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 rechanneling procedure is performed on both sides of the body during the same operative session, this modifier should be used to indicate a bilateral procedure.
3. Modifier 51 - Multiple Procedures: This modifier is applicable when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
4. Modifier 52 - Reduced Services: Use this modifier when the procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reason for the reduction.
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: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that each surgeon is performing a distinct part of the procedure.
7. Modifier 66 - Surgical Team: When a highly complex procedure requires the skills of several physicians, often of different specialties, this modifier indicates that a surgical team was involved.
8. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician on the same day, this modifier should be used.
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 modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
12. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier indicates their involvement.
13. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required on a minimal basis.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
15. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the service, this modifier indicates that multiple modifiers are being used.
Each modifier serves a specific purpose and should be used in accordance with the documentation and circumstances surrounding the procedure to ensure accurate billing and reimbursement.
CPT code 35363, which involves 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.
However, it's important to note that the reimbursement for CPT code 35363 can also vary based on the local coverage determinations made by the Medicare Administrative Contractors (MACs). MACs are responsible for processing Medicare claims and have the authority to establish specific coverage policies that can influence whether a particular service is reimbursed in their jurisdiction. Therefore, healthcare providers should consult both the MPFS and their respective MAC's guidelines to ascertain the reimbursement status and any specific requirements or documentation needed for CPT code 35363.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including CPT code 35363. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
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