CPT code 35452 is used for procedures involving the repair of an arterial blockage, ensuring proper blood flow through the arteries.
CPT code 35452 is used to describe a percutaneous transluminal balloon angioplasty procedure performed on an artery. This procedure involves the use of a balloon catheter to open up a blocked or narrowed artery, typically to improve blood flow. The balloon is inserted into the artery and then inflated at the site of the blockage, which helps to widen the artery and restore proper circulation. This code is specifically used for reporting the repair of arterial blockages through this minimally invasive technique.
For CPT code 35452, 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 26 - Professional Component: Used when only the professional component of the service is being billed, typically by a physician who interprets the results.
2. Modifier 50 - Bilateral Procedure: Applied if the procedure is performed on both sides of the body during the same session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
4. Modifier 52 - Reduced Services: Applied when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
7. Modifier 76 - Repeat Procedure by Same Physician: Applied when the same procedure is repeated by the same physician on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician on the same day.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Used when a related procedure is performed during the postoperative period due to complications.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Applied when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Applied when a minimum assistant surgeon is required for the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement. It is important to select the appropriate modifiers based on the specific details of the procedure performed.
CPT code 35452 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 policies set by the Medicare Administrative Contractor (MAC) for your specific region.
The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, the actual reimbursement can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) established by the MACs.
These contractors have the authority to interpret Medicare policies and decide on the coverage specifics for procedures like those associated with CPT code 35452. Therefore, it is essential for healthcare providers to verify the reimbursement status of CPT code 35452 with their local MAC to ensure compliance and proper billing practices.
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 35452, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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