CPT code 35400 is a medical code used to describe the procedure of angioscopy, which involves visual examination of blood vessels.
CPT code 35400 is used to describe the procedure of angioscopy. Angioscopy is a medical procedure that involves the direct visual examination of the interior of blood vessels using a specialized instrument called an angioscope. This procedure is typically performed to assess the condition of the blood vessels, identify blockages, or evaluate the success of previous interventions such as angioplasty. The angioscope is inserted into the blood vessel, often through a small incision, allowing healthcare providers to obtain real-time images and make informed decisions regarding patient care.
For CPT code 35400, which pertains to angioscopy, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the procedure, not the technical component.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the equipment, supplies, and technical support, not the professional interpretation.
3. 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 used when procedures are not normally reported together but are appropriate under the circumstances.
4. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same session. It indicates that the procedure is one of several performed on the same day.
5. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified healthcare professional.
6. Modifier 53 - Discontinued Procedure: This modifier is used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
7. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
8. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
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 a related procedure is performed during the postoperative period of the initial procedure.
10. 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.
These modifiers help provide additional information about the circumstances under which the angioscopy was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 35400 is associated with a procedure that may be reimbursed by Medicare, but its reimbursement is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines whether a specific CPT code is covered and the reimbursement rate for services provided to Medicare beneficiaries. To ascertain if CPT code 35400 is reimbursed, healthcare providers should consult the MPFS for the current year, as reimbursement rates and coverage can change annually.
Additionally, 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 local coverage determinations (LCDs) that can affect whether a particular service is reimbursed in their jurisdiction. Therefore, it is essential for healthcare providers to check with their specific MAC to understand any local policies or requirements that might impact the reimbursement of CPT code 35400.
In summary, while CPT code 35400 may be reimbursed by Medicare, providers must verify its status on the MPFS and consult their MAC for any specific coverage guidelines or restrictions.
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