CPT code 35493 is used for a procedure involving the removal of plaque from blood vessels using a catheter-based technique.
CPT code 35493 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 improve circulation, often used in cases of peripheral artery disease. By using specialized tools attached to the catheter, the physician can effectively shave or cut away the plaque, reducing blockages without the need for open surgery.
For CPT code 35493, which pertains to percutaneous atherectomy, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the atherectomy is performed on both sides of the body during the same session.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was conducted.
3. Modifier 59 - Distinct Procedural Service: This modifier is applied when the atherectomy is performed as a distinct and separate service from other procedures on the same day.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure, this modifier indicates the involvement of both professionals.
5. Modifier 76 - Repeat Procedure by Same Physician: Used when the same physician performs the atherectomy more than once on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if a different physician repeats the atherectomy on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: If the patient needs to return to the operating room for a related procedure during the postoperative period, this modifier is applicable.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when the atherectomy is unrelated to the original procedure and occurs during the postoperative period.
9. Modifier 80 - Assistant Surgeon: If an assistant surgeon is necessary for the procedure, this modifier is used to indicate their involvement.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Similar to Modifier 80, but specifically used when a qualified resident surgeon is unavailable.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 35493 is subject to reimbursement by Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set by the Medicare Administrative Contractor (MAC) in your region.
The MPFS provides a comprehensive list of services covered by Medicare, along with the associated reimbursement rates. Each MAC, which administers Medicare claims for specific geographic areas, may have additional local coverage determinations that affect whether CPT code 35493 is reimbursed.
Therefore, it is crucial for healthcare providers to verify the status of CPT code 35493 with their local MAC to ensure compliance with Medicare's reimbursement policies.
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