CPT code 35371 is used for the procedure involving the rechanneling of an artery to improve blood flow and restore proper circulation.
CPT code 35371 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 been narrowed or blocked. The procedure typically involves techniques such as endarterectomy, where plaque is removed from the artery, or bypass grafting, where a new pathway is created for blood flow. This code is essential for healthcare providers to accurately document and bill for the surgical intervention aimed at treating conditions like peripheral artery disease, ensuring proper reimbursement and tracking of healthcare services.
For CPT code 35371, which involves the rechanneling of an artery, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is 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: If the procedure is performed on both sides of the body, this modifier indicates that the service was bilateral.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was carried out.
4. 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.
5. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are equally responsible for the procedure.
6. Modifier 66 - Surgical Team: When a team of surgeons is necessary to perform the procedure, this modifier is used to indicate the involvement of multiple professionals.
7. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure on the same day, this modifier is used to indicate the repetition.
8. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a different physician repeats the procedure on the same day.
9. 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 the patient needs to return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
11. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required to help with the procedure, this modifier indicates their involvement.
12. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required on a limited basis.
13. 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.
14. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the service, this modifier is used to indicate the use of multiple modifiers.
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 to ensure accurate billing and reimbursement.
CPT code 35371, 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, the reimbursement for CPT code 35371 is not solely determined by the MPFS. 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 coverage decisions based on local policies and guidelines. They assess whether the service is medically necessary and meets the criteria for reimbursement in their specific jurisdiction.
Therefore, while CPT code 35371 may be listed on the MPFS, healthcare providers should verify with their local MAC to ensure that the service is covered and reimbursed under Medicare in their area. It is also advisable for providers to stay informed about any updates or changes to the MPFS and MAC policies that may affect the reimbursement status of this code.
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 specific codes like 35371. 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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