CPT code 35456 is used for procedures involving the repair of an arterial blockage, aiding in accurate documentation and reimbursement.
CPT code 35456 is used to describe a procedure known as transluminal balloon angioplasty, which is performed to repair an arterial blockage. This procedure involves the insertion of a small balloon-tipped catheter into a narrowed or blocked artery. Once in place, the balloon is inflated to widen the artery, improving blood flow and alleviating symptoms associated with the blockage. This code is specifically used for angioplasty procedures targeting arteries in the lower extremities, such as those in the legs. It is important for healthcare providers to accurately document this procedure using the correct CPT code to ensure proper billing and reimbursement.
For CPT code 35456, which pertains to the repair of an arterial blockage, the following modifiers may be applicable:
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 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier should be used to indicate that the service was bilateral.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same session, this modifier is used to indicate that more than one procedure was performed.
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, this modifier indicates that each surgeon performed a distinct part of the procedure.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier 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 when a patient returns 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 modifier is used when an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is 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 under which the procedure was performed, ensuring accurate billing and reimbursement. Always consult the latest coding guidelines and payer-specific policies to determine the appropriate use of modifiers.
The CPT code 35456 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 guidelines set forth by the respective Medicare Administrative Contractor (MAC) in your 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 for CPT code 35456 can vary based on local coverage determinations (LCDs) made by the MAC, which may impose specific criteria or documentation requirements for the procedure.
Therefore, it is crucial for healthcare providers to verify the specific coverage details and reimbursement rates for CPT code 35456 with their local MAC to ensure compliance and accurate billing.
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