CPT code 35474 is used for procedures involving the repair of an arterial blockage, ensuring proper blood flow through the arteries.
CPT code 35474 is used to describe a procedure known as transluminal balloon angioplasty, which is performed to repair an arterial blockage. This procedure involves the insertion of a balloon-tipped catheter into a narrowed or blocked artery. Once in place, the balloon is inflated to widen the artery, improving blood flow and alleviating symptoms associated with the blockage. This code specifically applies to angioplasty procedures conducted on arteries other than coronary, renal, or carotid arteries, and it is crucial for accurate billing and documentation in the healthcare revenue cycle.
For CPT code 35474, which involves the repair of an arterial blockage, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the professional component of a service is being billed separately from the technical component. It is applicable if the physician is only providing the interpretation of the procedure.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier should be used to indicate that the service was performed bilaterally.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same session, this modifier is used to indicate that more than one procedure was performed.
4. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: This modifier is 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: If two surgeons are required to perform the procedure, this modifier indicates that both surgeons are involved in the procedure.
7. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day.
8. 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.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used when a related procedure is performed during the postoperative period due to complications.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to assist with the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required for a minimal portion of the procedure.
13. 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.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 35474 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 associated payment rates. Each MAC, which administers Medicare benefits in different regions, may have specific local coverage determinations (LCDs) that influence whether a particular CPT code like 35474 is reimbursed.
Therefore, it is crucial for healthcare providers to verify the reimbursement status of CPT code 35474 by consulting the MPFS and the relevant MAC's policies to ensure compliance and proper billing practices.
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 35474. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and ensure you're receiving the full reimbursement you deserve.
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