CPT code 35484 is used to describe an open atherectomy procedure, which involves removing plaque from blood vessels to improve circulation.
CPT code 35484 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 the inside of an artery. This specific code indicates that the procedure is done via an open incision, allowing direct access to the artery to clear blockages and improve blood flow. This code is typically used by healthcare providers to document and bill for the surgical intervention aimed at treating peripheral artery disease or similar conditions.
For CPT code 35484, which pertains to an atherectomy procedure performed via an open approach, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:
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 procedure from other services 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: 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 applicable.
7. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician on the same day, this modifier is used.
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 the atherectomy is performed during the postoperative period of another procedure but is unrelated, this modifier is applicable.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier is used to indicate their involvement.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident is not available.
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 policies to ensure accurate billing and reimbursement.
CPT code 35484, which pertains to a specific medical procedure, is subject to reimbursement considerations under Medicare. To determine if this code is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the associated reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide guidance on whether CPT code 35484 is covered in specific regions or under particular circumstances. Coverage and reimbursement can vary based on local coverage determinations (LCDs) set by MACs, which consider regional medical necessity and other factors.
Therefore, healthcare providers should verify the inclusion of CPT code 35484 in the MPFS and consult their respective MAC for any regional coverage nuances to ensure proper reimbursement.
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