CPT code 35485 is used to describe an open atherectomy procedure, which involves removing plaque from blood vessels to improve blood flow.
CPT code 35485 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 direct incision to access the affected artery. This code is typically used by healthcare providers to document and bill for the specific service of removing blockages in arteries through open surgical methods.
For CPT code 35485, 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: 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 service from other procedures performed on the same day, which are not normally reported together.
4. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of the procedure.
5. Modifier 66 - Surgical Team: Applied when a team of surgeons is required to perform the procedure 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 returns 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 the atherectomy is performed during the postoperative period of another procedure but is unrelated to the initial surgery.
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 atherectomy was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines, as modifier usage can vary.
CPT code 35485, which pertains to a specific medical procedure, is subject to reimbursement considerations under Medicare. To determine if Medicare reimburses this code, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered.
Additionally, it is important to consult with the relevant Medicare Administrative Contractor (MAC) for your region. MACs are private organizations that have been contracted by Medicare to process claims and determine coverage specifics, including whether a particular CPT code like 35485 is reimbursable. They provide guidance on local coverage determinations (LCDs) and can offer insights into any specific documentation or billing requirements that may affect reimbursement.
Therefore, while the MPFS provides a general framework for reimbursement, the final determination often rests with the MAC, which considers both national and local policies. Healthcare providers should ensure they are in compliance with both MPFS guidelines and MAC directives to optimize reimbursement for CPT code 35485.
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