CPT code 35480 is used to describe the procedure of removing plaque from an artery through an open surgical method.
CPT code 35480 is used to describe an atherectomy procedure performed through an open surgical approach. An atherectomy is a medical procedure that involves the removal of plaque from a blood vessel. This code specifically refers to the open method, meaning the surgeon makes an incision to access the affected blood vessel directly. The goal of this procedure is to restore normal blood flow by eliminating blockages caused by plaque buildup, which can help prevent complications such as heart attacks or strokes. This code is essential for healthcare providers to accurately document and bill for the services rendered during this specific type of vascular surgery.
For CPT code 35480, which pertains to an open atherectomy procedure, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the atherectomy is performed on both sides of the body during the same operative session.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that the atherectomy is one of several procedures.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the atherectomy is a distinct service from other procedures performed on the same day, which are not normally reported together.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the atherectomy due to its complexity, this modifier indicates that both surgeons are involved in the procedure.
5. Modifier 66 - Surgical Team: When a surgical team is necessary to perform the atherectomy, this modifier is used to reflect the involvement of multiple professionals.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician performs the atherectomy more than once on the same day, this modifier is used to indicate the repeat procedure.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a different physician repeats the atherectomy on the same day.
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: If the patient needs to return to the operating room for a related procedure during the postoperative period, this modifier is applicable.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when the atherectomy is performed during the postoperative period of another procedure but is unrelated to the initial surgery.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the atherectomy, this modifier indicates their involvement.
11. 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.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician practitioner assists in the surgery.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association and payer-specific policies to ensure accurate billing and reimbursement.
CPT code 35480 is subject to reimbursement by Medicare, but its eligibility for payment 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) for the region in which the service is provided.
The MPFS outlines the payment rates for services covered by Medicare, and each MAC may have additional local coverage determinations that affect whether and how a particular CPT code is reimbursed.
Therefore, healthcare providers should verify the reimbursement status of CPT code 35480 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 identifying underpayments down to the CPT code level, including CPT code 35480, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
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
