CPT code 35476 is used for procedures involving the repair of a venous blockage, helping streamline healthcare documentation and reimbursement.
CPT code 35476 is used to describe a medical procedure that involves the repair of a venous blockage. This procedure typically involves techniques such as angioplasty, where a balloon is inserted and inflated to open up the blocked vein, improving blood flow. It is a critical intervention for patients experiencing issues related to venous obstructions, which can lead to complications such as swelling, pain, or more severe circulatory problems. This code is utilized by healthcare providers to accurately document and bill for the procedure, ensuring proper reimbursement and record-keeping within the healthcare revenue cycle.
For CPT code 35476, which involves the repair of a venous 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 providing only the interpretation of the procedure.
2. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body during the same session. It indicates that the procedure was performed bilaterally.
3. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It helps in identifying that more than one procedure was conducted.
4. Modifier 52 - Reduced Services: This modifier is applicable if the procedure was partially reduced or eliminated at the physician's discretion. It indicates that the full service was not provided.
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. It is used to avoid bundling issues.
6. 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. It indicates that the procedure was necessary to be repeated.
7. 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. It indicates that the procedure was necessary to be repeated by another 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: This modifier is used when a patient requires a return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required during the procedure. It indicates that another surgeon assisted in the procedure.
These modifiers help in providing additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 35476, which involves the repair of a venous blockage, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource in determining whether a specific CPT code is reimbursed and at what rate. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals to Medicare beneficiaries.
However, it's important to note that the reimbursement for CPT code 35476 can also be influenced by the local coverage determinations (LCDs) set forth by the Medicare Administrative Contractor (MAC) in your region. MACs are responsible for processing Medicare claims and have the authority to establish specific coverage policies that may affect whether a particular service is reimbursed.
Therefore, to ascertain if CPT code 35476 is reimbursed by Medicare, healthcare providers should consult the MPFS for the national payment rate and also review any relevant LCDs issued by their MAC. This dual approach ensures compliance with both national and regional Medicare policies.
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