CPT code 35475 is used for procedures involving the repair of an arterial blockage, helping to restore proper blood flow in the affected artery.
CPT code 35475 is used to describe a percutaneous transluminal procedure aimed at repairing an arterial blockage. This procedure involves the use of a catheter to access the blocked artery and typically employs a balloon to dilate the vessel, thereby restoring adequate blood flow. It is a minimally invasive technique often used to treat conditions such as peripheral artery disease. The code is essential for billing purposes, ensuring that healthcare providers are accurately reimbursed for the specific services rendered during the procedure.
For CPT code 35475, 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 that could be used:
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 indicates that the service was bilateral.
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 conducted.
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 is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. 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.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated by a different physician.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room: If there is an unplanned return to the operating room for a related procedure during the postoperative period, this modifier is used.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier is used to indicate their involvement.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
12. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the service, this modifier is used to indicate the use of multiple modifiers.
Each of these modifiers provides additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is crucial to select the appropriate modifier(s) to reflect the specific details of the service provided.
The CPT code 35475 is subject to reimbursement by Medicare, but its reimbursement is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in determining the reimbursement rates for services covered under Medicare Part B, including those associated with CPT codes. To ascertain whether CPT code 35475 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the specific payment rates applicable.
Additionally, Medicare Administrative Contractors (MACs) are responsible for processing claims and providing guidance on coverage policies within their respective jurisdictions. Each MAC may have specific local coverage determinations (LCDs) that can affect whether CPT code 35475 is reimbursed. Providers should review the LCDs and any related articles published by their regional MAC to ensure compliance with Medicare's coverage criteria and documentation requirements.
In summary, while CPT code 35475 can be reimbursed by Medicare, providers must verify its inclusion in the MPFS and adhere to any guidelines or requirements set forth by their MAC to ensure successful reimbursement.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including CPT code 35475, RevFind provides unparalleled insight into your revenue streams. Schedule a demo today to see how RevFind can identify discrepancies with individual payers and enhance your financial performance.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
