CPT code 35458 is used for procedures involving the repair of an arterial blockage, helping streamline healthcare documentation and reimbursement.
CPT code 35458 is used to describe a procedure involving the repair of an arterial blockage. This code specifically pertains to the transluminal balloon angioplasty of an artery, which is a minimally invasive procedure. During this procedure, a catheter with a small balloon on its tip is inserted into the blocked artery. Once in place, the balloon is inflated to widen the artery, improving blood flow and alleviating the blockage. This code is crucial for healthcare providers to accurately document and bill for the procedure, ensuring proper reimbursement and maintaining precise medical records.
For CPT code 35458, 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 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier is used to indicate that the procedure was bilateral.
3. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed.
4. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. 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 to identify procedures that are not normally reported together but are appropriate under the circumstances.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: 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.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: 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.
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 requires 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 During the Postoperative Period: This modifier is used when an unrelated procedure or service 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 during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
13. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service performed.
Each modifier should be used in accordance with the specific details of the procedure and the payer's guidelines. Proper documentation is essential to support the use of any modifier.
CPT code 35458 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 specific guidelines set by the Medicare Administrative Contractor (MAC) for the region where the service is provided.
The MPFS outlines the payment rates for services covered by Medicare, and CPT code 35458 would need to be listed there to be eligible for reimbursement.
Additionally, MACs have the authority to interpret national policies and may have local coverage determinations (LCDs) that affect the reimbursement of specific codes like 35458.
Therefore, healthcare providers should verify the MPFS and consult their regional MAC to determine if CPT code 35458 is reimbursed by Medicare in their specific circumstances.
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