CPT code 35482 is used for describing an open atherectomy procedure, which involves removing plaque from blood vessels to improve circulation.
CPT code 35482 is used to describe an open atherectomy procedure. This procedure involves the surgical removal of plaque from an artery. The goal of an atherectomy is to restore proper blood flow by eliminating blockages caused by the buildup of fatty deposits or calcium within the arterial walls. This code is specifically used when the procedure is performed through an open surgical approach, as opposed to minimally invasive techniques. Proper documentation and coding of this procedure are crucial for accurate billing and reimbursement in the healthcare revenue cycle.
For CPT code 35482, which pertains to an atherectomy procedure performed via an open approach, the following modifiers may be applicable:
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. It indicates that the procedure was performed bilaterally.
2. Modifier 51 - Multiple Procedures: If the atherectomy is performed in conjunction with other procedures during the same surgical session, this modifier is used to indicate multiple procedures.
3. Modifier 59 - Distinct Procedural Service: This modifier is applied when the atherectomy is performed as a distinct and separate service from other procedures performed on the same day. It is used to prevent bundling of services that are typically considered inclusive.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the atherectomy due to its complexity, this modifier indicates that the procedure was a co-surgery.
5. Modifier 66 - Surgical Team: This modifier is used when the procedure requires a surgical team due to its complexity or the patient's condition.
6. Modifier 76 - Repeat Procedure by Same Physician: If the atherectomy needs to be repeated by the same physician on the same day, this modifier is used to indicate the repeat service.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the atherectomy is repeated by a different physician 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: This modifier is used if the patient needs to 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: If an unrelated procedure is performed by the same physician during the postoperative period of the initial atherectomy, this modifier is used.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help perform the atherectomy.
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 surgeon.
These modifiers help provide additional information about the circumstances under which the atherectomy was performed, ensuring accurate billing and reimbursement.
CPT code 35482 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the specific Medicare Administrative Contractor (MAC) that governs the region where the service is provided.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. If CPT code 35482 is listed in the MPFS, it indicates that Medicare has established a payment rate for this service, subject to any local coverage determinations (LCDs) or national coverage determinations (NCDs) that may apply.
Additionally, MACs play a crucial role in determining reimbursement as they process Medicare claims and have the authority to establish specific coverage policies within their jurisdictions. Each MAC may have different guidelines or requirements for the reimbursement of CPT code 35482, which can affect whether and how much Medicare will reimburse for this service.
Healthcare providers should verify the inclusion of CPT code 35482 in the MPFS and consult with their local MAC to understand any specific coverage criteria or documentation requirements that may impact reimbursement.
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