CPT code 35459 is used for procedures involving the repair of an arterial blockage, ensuring proper blood flow through the arteries.
CPT code 35459 is used to describe a procedure involving the repair of an arterial blockage through a transluminal approach. This means that a healthcare provider uses a minimally invasive technique to access and treat the blockage within an artery. The procedure typically involves the use of a catheter, which is inserted into the artery to reach the site of the blockage. Once there, various methods such as balloon angioplasty or atherectomy may be employed to restore normal blood flow. This code is crucial for billing and documentation purposes, ensuring that healthcare providers are accurately reimbursed for the specialized care they deliver in managing arterial blockages.
For CPT code 35459, 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 when 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. This modifier indicates that multiple services were provided.
3. Modifier 52 - Reduced Services: Used 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. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. Modifier 62 - Two Surgeons: Applied when two surgeons work together as primary surgeons performing distinct parts of a procedure.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: 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: 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 During the Postoperative Period: Used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: Indicates that an assistant surgeon was required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon provides minimal assistance.
12. 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.
13. Modifier 99 - Multiple Modifiers: Used when two or more modifiers are necessary to describe the service provided.
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 the use of modifiers can vary between insurance carriers.
CPT code 35459 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) in 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 final decision on whether CPT code 35459 is reimbursed can vary based on local coverage determinations (LCDs) made by the MACs.
These contractors have the authority to establish specific guidelines and requirements for coverage, which may include documentation, medical necessity, and other criteria. Therefore, it is essential for healthcare providers to consult the MPFS and their regional MAC to confirm the reimbursement status and any specific conditions that must be met for CPT code 35459.
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 specific codes like 35459. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
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