CPT code 35470 is used for procedures involving the repair of an arterial blockage, helping healthcare providers document and categorize services.
CPT code 35470 is used to describe a procedure for the repair of an arterial blockage through a percutaneous transluminal approach. This involves the use of a catheter to access the blocked artery and restore normal blood flow, typically by inflating a balloon to compress the blockage against the artery walls. This minimally invasive technique is often employed to treat conditions such as peripheral artery disease, where plaque buildup restricts blood flow in the arteries.
For CPT code 35470, which pertains to the repair of an arterial blockage, the following modifiers may be applicable. These modifiers are used to provide additional information about the procedure performed and to ensure accurate billing and reimbursement:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body. It indicates that the same procedure was carried out on a mirrored anatomical site.
2. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was conducted.
3. Modifier 59 - Distinct Procedural Service: This modifier is applied when 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 typically reported together but are appropriate under the circumstances.
4. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician on the same day, this modifier is used to indicate the repetition.
5. 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.
6. 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 an unplanned return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure is performed during the postoperative period of another procedure, but the two are unrelated.
8. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
9. Modifier 81 - Minimum Assistant Surgeon: This modifier indicates that a minimum assistant surgeon was necessary for the procedure.
10. 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.
These modifiers help clarify the circumstances under which the procedure was performed and ensure that healthcare providers receive appropriate reimbursement for their services. It's important to select the correct modifier to avoid claim denials or payment delays.
CPT code 35470 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered.
Whether CPT code 35470 is reimbursed by Medicare depends on several factors, including the specific guidelines and policies set forth by the Medicare Administrative Contractor (MAC) in your region. MACs are responsible for processing Medicare claims and have the authority to determine coverage and payment policies for services, including those associated with CPT code 35470.
Therefore, it is essential for healthcare providers to consult the local MAC for the most accurate and up-to-date information regarding the reimbursement status of CPT code 35470 under Medicare.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including CPT code 35470, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
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