CPT code 35450 is used for procedures involving the repair of an arterial blockage, ensuring proper blood flow is restored in the affected artery.
CPT code 35450 is used to describe a procedure for the repair of an arterial blockage through a technique known as transluminal angioplasty. This procedure involves the use of a balloon catheter to open up narrowed or blocked blood vessels, specifically arteries, to improve blood flow. It is typically performed by a vascular surgeon or an interventional radiologist and is often used to treat conditions such as peripheral artery disease. The procedure is minimally invasive and can help alleviate symptoms like pain and cramping in the legs due to poor circulation.
For CPT code 35450, which pertains to the repair of an arterial blockage, 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 procedure is performed on both sides of the body during the same operative session.
2. Modifier 51 - Multiple Procedures: This is applied when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is 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 procedure due to its complexity, this modifier is used to indicate that both surgeons are primary and are working together as co-surgeons.
5. Modifier 66 - Surgical Team: This is applicable when a highly complex procedure requires the services of several physicians, often of different specialties, working together as a team.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This is used when the same 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: 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: This is used when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help with the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This is used when an assistant surgeon is required for a minimal portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 35450 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the specific Medicare Administrative Contractor (MAC) overseeing the region where the service is provided.
The MPFS outlines the payment rates for services covered by Medicare, and each MAC may have additional guidelines or requirements that influence reimbursement decisions.
Therefore, healthcare providers should verify the status of CPT code 35450 with their local MAC and consult the latest MPFS to determine its eligibility for reimbursement under Medicare.
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