CPT code 35481 is used for describing an open atherectomy procedure, which involves removing plaque from blood vessels to improve circulation.
CPT code 35481 is used to describe an atherectomy procedure performed through an open surgical approach. An atherectomy is a medical procedure used to remove plaque from blood vessels, particularly arteries, to improve blood flow. This specific code indicates that the procedure was done by making an incision to access the affected vessel directly, rather than using a minimally invasive technique. This code is crucial for healthcare providers to accurately document and bill for the services provided, ensuring proper reimbursement and maintaining compliance with healthcare regulations.
For CPT code 35481, 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 was a distinct procedure from other services performed on the same day, often due to different anatomical sites or separate incisions.
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 the procedure requires a team of surgeons due to its complexity, this modifier is used to denote the involvement of a surgical team.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the atherectomy procedure on the same day, this modifier is used.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if a different physician repeats the atherectomy procedure on the same day.
8. Modifier 78 - Unplanned Return to the Operating Room: 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 if 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 necessary for the procedure, this modifier indicates their involvement.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required due to the unavailability of a qualified resident.
These modifiers help provide additional context and specificity to the billing and documentation of the procedure, ensuring accurate reimbursement and compliance with payer requirements.
CPT code 35481, which pertains to a specific medical procedure, is subject to reimbursement by Medicare, but this depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines the reimbursement rates for services covered under Medicare Part B. To ascertain if CPT code 35481 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the associated payment rates.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make coverage determinations that can vary by region. Therefore, it is essential for healthcare providers to check with their specific MAC to confirm if CPT code 35481 is covered and to understand any local coverage determinations or specific billing requirements that may apply.
In summary, while CPT code 35481 may be reimbursed by Medicare, providers must review the MPFS and consult their MAC to ensure compliance with all applicable guidelines and to determine the exact reimbursement details.
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