CPT code 35460 is used for procedures involving the repair of a venous blockage, helping streamline healthcare documentation and reimbursement.
CPT code 35460 is used to describe a medical procedure that involves the repair of a venous blockage. This procedure is typically performed to restore normal blood flow in veins that have become narrowed or obstructed. It may involve techniques such as angioplasty, where a balloon is used to widen the vein, or other methods to remove or bypass the blockage. This code is crucial for healthcare providers to accurately document and bill for the services provided during the treatment of venous blockages.
For CPT code 35460, which pertains to the repair of a venous 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, such as the interpretation of a diagnostic test.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier indicates 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 additional procedures were carried out.
4. Modifier 52 - Reduced Services: This modifier is applicable if the procedure was partially reduced or eliminated at the discretion of the physician.
5. Modifier 59 - Distinct Procedural Service: This is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician, this modifier is used to denote the repetition.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the procedure is repeated by a different physician.
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 is used when a related procedure is performed during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier indicates that a procedure performed during the postoperative period was unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier is used.
11. Modifier 81 - Minimum Assistant Surgeon: This is used when a minimum assistant surgeon is involved in the procedure.
12. 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.
13. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the service, this modifier is used to indicate the use of multiple modifiers.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It's important to select the appropriate modifiers based on the specific details of the procedure and the clinical scenario.
CPT code 35460 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 policies of the specific Medicare Administrative Contractor (MAC) overseeing the region where the service is provided.
The MPFS outlines the payment rates for services covered by Medicare Part B, and each MAC may have additional guidelines or requirements for coverage.
Providers should verify the reimbursement status of CPT code 35460 by consulting the MPFS and checking with their local MAC to ensure compliance with any regional policies or documentation requirements.
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