CPT code 35490 is a medical code used to describe a minimally invasive procedure to remove plaque from blood vessels.
CPT code 35490 is used to describe a percutaneous atherectomy procedure. This is a minimally invasive surgical technique where a catheter is inserted through the skin to remove plaque from a blood vessel. The goal of this procedure is to restore proper blood flow by clearing blockages in the arteries, often in the peripheral vascular system. This code is typically used by healthcare providers to document and bill for the procedure when performed on patients who have conditions such as peripheral artery disease (PAD).
For CPT code 35490, which pertains to atherectomy percutaneous, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 26 - Professional Component: This modifier is used when the professional component of the service is being billed separately from the technical component. It is applicable if the physician is providing only the interpretation of the procedure.
2. Modifier 50 - Bilateral Procedure: If the atherectomy is performed on both sides of the body during the same session, this modifier should be used to indicate a bilateral procedure.
3. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed and helps in the correct reimbursement of services.
4. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used to indicate that the service provided was less than usually required.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are equally responsible for the procedure.
7. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician on the same day, this modifier is used to indicate that the procedure was repeated.
8. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician on the same day, this modifier is used to indicate the repeat service.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used when a patient returns to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier indicates the involvement of an assistant.
12. 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 in accurately describing the circumstances under which the procedure was performed and ensure appropriate billing and reimbursement. It is crucial to review the specific payer policies and guidelines, as they may have unique requirements for modifier usage.
CPT code 35490, which involves atherectomy percutaneous, is subject to reimbursement by Medicare, but this depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines whether a specific CPT code is reimbursable and at what rate. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals under Medicare Part B.
However, it's important to note that the reimbursement for CPT code 35490 can also be influenced by the local coverage determinations (LCDs) made by Medicare Administrative Contractors (MACs). MACs are responsible for processing Medicare claims and have the authority to establish specific coverage policies within their jurisdictions. These policies can vary, meaning that while CPT code 35490 may be reimbursed in one region, it might not be in another, depending on the MAC's guidelines.
Therefore, healthcare providers should consult both the MPFS and their respective MAC's LCDs to determine the reimbursement eligibility and requirements for CPT code 35490. This ensures compliance with Medicare's billing policies and maximizes the potential for successful reimbursement.
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