CPT code 35492 is used for a minimally invasive procedure to remove plaque from blood vessels, improving blood flow and reducing blockages.
CPT code 35492 is used to describe a percutaneous atherectomy procedure. This is a minimally invasive surgical technique where a catheter is inserted into a blood vessel to remove plaque buildup from the inside of an artery. The goal of this procedure is to restore proper blood flow and reduce the risk of complications associated with blocked arteries, such as heart attacks or strokes. This code is typically used by healthcare providers to document and bill for the specific service of performing an atherectomy without the need for open surgery.
For CPT code 35492, which pertains to percutaneous atherectomy, 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 a service is being billed separately from the technical component. It indicates that the provider is billing only for the professional services rendered, such as interpretation or supervision.
2. Modifier 50 - Bilateral Procedure: If the atherectomy is performed on both sides of the body during the same session, this modifier is used to indicate a bilateral procedure.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was performed.
4. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified healthcare professional.
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, this modifier indicates that each surgeon is performing a distinct part of the procedure.
7. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day.
9. 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 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: This modifier is used when an assistant surgeon is required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 35492, which involves atherectomy percutaneous, is subject to reimbursement by Medicare, but this is contingent upon several factors. Medicare reimbursement for any CPT code, including 35492, is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries. The MPFS is updated annually and takes into account various factors such as geographic location and practice expenses.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make local coverage determinations (LCDs) that can affect whether a particular service is reimbursed in their jurisdiction. Therefore, while CPT code 35492 may be listed on the MPFS, its reimbursement can vary based on the specific policies and guidelines set forth by the MACs in different regions.
Healthcare providers should verify the current MPFS and consult with their respective MAC to ensure that CPT code 35492 is covered and to understand any specific documentation or billing requirements that may apply.
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