CPT code 35501 is used for procedures involving an arterial bypass graft on the same side of the carotid artery.
CPT code 35501 is used to describe a surgical procedure known as an "arterial bypass graft" specifically involving the ipsilateral carotid artery. This procedure is performed to redirect blood flow around a blocked or narrowed section of the carotid artery, which is located on the same side of the body as the blockage. The goal of this surgery is to improve blood circulation to the brain, thereby reducing the risk of stroke or other complications associated with reduced blood flow. The procedure involves creating a bypass using a graft, which can be a vein or synthetic material, to reroute the blood flow around the obstructed area.
For CPT code 35501, which pertains to an arterial bypass graft involving the ipsilateral carotid artery, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to increased complexity or difficulty of the procedure.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that the procedure is one of several performed.
3. 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.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is used to indicate the collaborative effort.
5. Modifier 66 - Surgical Team: This modifier is applicable when a complex procedure requires the services of a surgical team.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician repeats the procedure on the same day, this modifier is used to indicate the repeat service.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated by a different physician 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: This modifier is used when a patient requires a return 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: This modifier is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help with the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier indicates that a minimum assistant surgeon was required for 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 the applicability of modifiers can vary.
CPT code 35501 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies set forth by the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for their services. However, the final determination of whether CPT code 35501 is reimbursed can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) established by the MAC.
Therefore, it is essential for healthcare providers to verify the specific guidelines and reimbursement rates with their regional MAC to ensure compliance and accurate billing.
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