CPT code 35491 is a medical code used to describe a procedure where a catheter is used to remove plaque from blood vessels.
CPT code 35491 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 blood vessels. The goal of this procedure is to restore proper blood flow in arteries that have been narrowed or blocked due to atherosclerosis. By using specialized tools attached to the catheter, the physician can effectively shave or cut away the plaque, improving circulation and reducing the risk of complications such as heart attack or stroke. This code is essential for healthcare providers to accurately document and bill for the procedure performed.
For CPT code 35491, which pertains to atherectomy percutaneous, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, such as the interpretation of the procedure by a physician.
2. Modifier 50 - Bilateral Procedure: Applied if the atherectomy is performed on both sides of the body during the same session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session, indicating that the atherectomy is one of several procedures.
4. Modifier 52 - Reduced Services: Applied if the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that the atherectomy is a distinct service from other procedures performed on the same day.
6. Modifier 62 - Two Surgeons: Applied when two surgeons are required to perform the procedure due to its complexity.
7. Modifier 76 - Repeat Procedure by Same Physician: Used if the same physician repeats the atherectomy procedure on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician: Applied if another physician repeats the atherectomy procedure on the same day.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Used if the 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: Applied if the atherectomy is performed during the postoperative period of another procedure but is unrelated.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
12. 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.
These modifiers help provide additional information about the circumstances under which the atherectomy procedure was performed, ensuring accurate billing and reimbursement.
CPT code 35491, which pertains to a specific medical procedure, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines the reimbursement rates for services covered under Medicare Part B. To ascertain if CPT code 35491 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the associated payment rates.
Additionally, Medicare Administrative Contractors (MACs) play a pivotal role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that may affect the reimbursement of specific CPT codes. Therefore, it is essential for healthcare providers to check with their respective MAC to ensure that CPT code 35491 is covered and to be aware of any specific documentation or medical necessity requirements that may apply.
In summary, while CPT code 35491 can be reimbursed by Medicare, providers must verify its inclusion in the MPFS and consult their MAC for any additional coverage criteria or requirements.
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