CPT code 35471 is used for procedures involving the repair of an arterial blockage, ensuring proper blood flow through the arteries.
CPT code 35471 is used to describe a procedure involving the repair of an arterial blockage through a technique known as transluminal angioplasty. This procedure is typically performed to restore proper blood flow in an artery that has been narrowed or blocked due to plaque buildup. During the procedure, a catheter with a small balloon on its tip is inserted into the affected artery. Once in place, the balloon is inflated to widen the artery, compressing the plaque against the artery walls and improving blood circulation. This code is essential for healthcare providers to accurately document and bill for the angioplasty procedure, ensuring appropriate reimbursement and maintaining precise medical records.
For CPT code 35471, which pertains to the repair of an arterial blockage, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their reasons for use:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 50 - Bilateral Procedure: Applied if the procedure is performed on both sides of the body during the same session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is part of a series of procedures.
4. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the discretion of the physician.
5. 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.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used when the same procedure is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used when the same procedure is repeated by a different provider.
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: Used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same provider during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimal assistant surgeon is required.
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 of the procedure, ensuring accurate billing and reimbursement. It's important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 35471 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) in your region.
The MPFS provides a comprehensive list of services covered by Medicare and assigns relative value units (RVUs) to each service, which are used to determine reimbursement rates.
However, the final decision on reimbursement can also be influenced by local coverage determinations (LCDs) issued by the MAC, which may vary based on geographic location and specific medical necessity criteria.
Therefore, it is essential for healthcare providers to verify the reimbursement status of CPT code 35471 with their respective MAC and ensure compliance with any applicable LCDs to secure Medicare reimbursement.
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