CPT code 35454 is used to describe a medical procedure for repairing an arterial blockage, aiding in accurate documentation and reimbursement.
CPT code 35454 is used to describe a medical procedure that involves the repair of an arterial blockage. This procedure typically involves techniques such as angioplasty, where a balloon is inserted and inflated to open up the blocked artery, improving blood flow. It is a critical intervention for patients with conditions like peripheral artery disease, where blockages can lead to serious complications if not addressed. This code is utilized by healthcare providers to accurately document and bill for the procedure, ensuring proper reimbursement and tracking of healthcare services provided.
For CPT code 35454, 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: Used if the procedure is performed on both sides of the body during the same session.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session.
3. Modifier 52 - Reduced Services: Utilized when the procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 59 - Distinct Procedural Service: Indicates that a procedure or service was distinct or independent from other services performed on the same day.
5. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
6. Modifier 76 - Repeat Procedure by Same Physician: Applied when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Indicates a return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician: Used for an unrelated procedure or service by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Applied when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary, and 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 payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 35454 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource for determining if a specific CPT code, such as 35454, is covered and at what rate. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals to Medicare beneficiaries.
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 coverage determinations based on local policies and guidelines. They may have specific Local Coverage Determinations (LCDs) that affect whether CPT code 35454 is reimbursed in their jurisdiction.
To ascertain if CPT code 35454 is reimbursed by Medicare, healthcare providers should consult the MPFS for the national payment rate and check with their respective MAC for any local coverage policies that might influence reimbursement. It's important to stay updated with any changes in these resources, as reimbursement policies can evolve over time.
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