CPT code 35473 is used for procedures involving the repair of an arterial blockage, ensuring proper blood flow through the arteries.
CPT code 35473 is used to describe a percutaneous transluminal balloon angioplasty procedure performed on an artery in the lower extremity. This code specifically refers to the repair of an arterial blockage by using a balloon catheter to widen the narrowed or obstructed blood vessel, thereby improving blood flow. This minimally invasive procedure is typically performed to treat conditions such as peripheral artery disease (PAD) and is crucial for restoring adequate circulation to the affected limb.
When dealing with CPT code 35473 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 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body during the same session.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was carried out.
3. 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.
4. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician, 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.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room: If the patient returns to the operating room for a related procedure during the postoperative period, this modifier is applicable.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when a procedure is performed by the same physician during the postoperative period of another procedure, but it is unrelated to the original procedure.
8. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier is used to indicate their involvement.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is necessary, and a qualified resident is not available.
10. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the service, this modifier is used to indicate that multiple modifiers apply.
Each of these modifiers 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 35473 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 guidelines set forth 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 actual reimbursement for CPT code 35473 can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) issued by the MACs.
These contractors are responsible for interpreting Medicare policies and ensuring that claims are processed correctly in their jurisdictions. Therefore, it is essential for healthcare providers to verify the specific coverage details and reimbursement rates for CPT code 35473 with their respective MAC to ensure compliance and accurate billing.
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 specific codes like 35473. Schedule a demo today to see how RevFind can help you ensure you're receiving the full reimbursement you deserve from each payer.
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