CPT code 35483 is used for describing an open atherectomy procedure, which involves removing plaque from blood vessels to improve circulation.
CPT code 35483 is used to describe an open atherectomy procedure. This procedure involves the surgical removal of plaque from an artery to restore proper blood flow. Unlike minimally invasive techniques, an open atherectomy requires a more extensive surgical approach, where the surgeon makes an incision to access the affected artery directly. This code is typically used in cases where less invasive methods are not suitable or have been unsuccessful, and it is crucial for healthcare providers to accurately document this procedure for appropriate billing and reimbursement.
For CPT code 35483, which pertains to an atherectomy procedure performed via an open approach, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: Used if the atherectomy is performed on both sides of the body during the same operative session.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures, including the atherectomy, are performed during the same surgical session.
3. Modifier 59 - Distinct Procedural Service: Utilized to indicate that the atherectomy is a distinct procedure from others performed on the same day, often due to different anatomical sites or separate patient encounters.
4. Modifier 62 - Two Surgeons: Used when two surgeons are required to perform the procedure together, each acting as a primary surgeon.
5. Modifier 66 - Surgical Team: Applied when the procedure requires a surgical team due to its complexity.
6. Modifier 76 - Repeat Procedure by Same Physician: Used if the same physician repeats the atherectomy procedure on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Applied when a different physician repeats the atherectomy procedure 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: 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: Applied when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required to help perform the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Applied 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 procedure was performed, ensuring accurate billing and reimbursement. Always verify with current coding guidelines and payer-specific requirements, as these can change over time.
The CPT code 35483 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, the final decision on whether a specific service is reimbursed, and at what rate, can vary based on local coverage determinations made by the MAC.
Therefore, it is essential for healthcare providers to consult the MPFS and their regional MAC to confirm the reimbursement status and any specific billing requirements for CPT code 35483.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 35483. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
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