CPT code 35472 is used for procedures involving the repair of an arterial blockage, ensuring proper blood flow in the affected area.
CPT code 35472 is used to describe a procedure that involves the repair of an arterial blockage. This code specifically refers to a percutaneous transluminal angioplasty, which is a minimally invasive procedure aimed at restoring proper blood flow through an artery that has been narrowed or blocked. During this 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, thereby improving blood circulation. This code is essential for healthcare providers to accurately document and bill for the angioplasty procedure performed to address arterial blockages.
When dealing with CPT code 35472 for 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 that could be used:
1. Modifier 26 (Professional Component): 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): 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.
4. Modifier 52 (Reduced Services): Indicates that the service was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 (Distinct Procedural Service): Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 62 (Two Surgeons): Applied when two surgeons work together as primary surgeons performing distinct parts of a procedure.
7. Modifier 76 (Repeat Procedure by Same Physician): Used when the same procedure is repeated by the same physician.
8. Modifier 77 (Repeat Procedure by Another Physician): Used when the same procedure is repeated by a different physician.
9. Modifier 78 (Unplanned Return to the Operating/Procedure Room): Indicates an unplanned return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 (Unrelated Procedure or Service by the Same Physician): Used when an unrelated procedure is performed by the same physician during the postoperative period.
11. Modifier 80 (Assistant Surgeon): Indicates that an assistant surgeon was required for the procedure.
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 surgeon.
13. Modifier 99 (Multiple Modifiers): Used when two or more modifiers are necessary to describe the service provided.
Each modifier serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies to ensure accurate billing and reimbursement.
CPT code 35472 is subject to reimbursement by 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 forth by the Medicare Administrative Contractor (MAC) in your region.
The MPFS provides a comprehensive list of services covered by Medicare, along with the payment rates for each service. However, coverage can vary based on local coverage determinations (LCDs) made by the MAC, which administers Medicare claims and can impose additional requirements or restrictions.
Therefore, it is crucial for healthcare providers to verify the reimbursement status of CPT code 35472 with their respective MAC to ensure compliance with Medicare's billing and coverage policies.
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 CPT code 35472, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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