CPT code 35506 is used for a surgical procedure involving an artery bypass graft from the subclavian to the carotid artery.
CPT code 35506 is used to describe a surgical procedure involving an arterial bypass graft from the subclavian artery to the carotid artery. This procedure is typically performed to improve blood flow in patients with significant blockages or narrowing in these arteries, which can lead to reduced blood supply to the brain and upper extremities. The bypass graft involves creating a new pathway for blood to flow, using either a synthetic graft or a section of the patient's own vein, to circumvent the obstructed area and restore adequate circulation.
When dealing with CPT code 35506, which involves an arterial bypass graft from the subclavian to the carotid artery, there are several modifiers that may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their purposes:
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 factors such as increased complexity or time.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was performed.
3. Modifier 52 - Reduced Services: This is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. 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.
5. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are actively involved.
6. Modifier 66 - Surgical Team: This is used when a team of surgeons is required to perform the procedure due to its complexity.
7. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician, this modifier is used to indicate the repetition.
8. Modifier 77 - Repeat Procedure by Another Physician: This is used when the procedure is repeated by a different physician.
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 is used when a procedure is performed during the postoperative period that is unrelated to the original procedure.
11. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help perform the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: This is used when an assistant surgeon is required on a minimal basis.
13. 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.
The use of these modifiers should be carefully considered and documented to ensure accurate billing and reimbursement. Each modifier serves a specific purpose and should be applied in accordance with the specific circumstances of the procedure performed.
The CPT code 35506 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource for understanding whether a specific CPT code, such as 35506, is reimbursed and at what rate. The MPFS outlines the payment rates for services provided to Medicare beneficiaries and is updated annually to reflect changes in policy and practice.
However, it's important to note that the reimbursement for CPT code 35506 can also be influenced by the local policies of the Medicare Administrative Contractor (MAC) that services your geographic area. MACs are responsible for processing Medicare claims and have the authority to make determinations on coverage and payment for specific services. They may have local coverage determinations (LCDs) that affect whether and how a particular service is reimbursed.
Therefore, to confirm the reimbursement status of CPT code 35506, healthcare providers should consult the latest MPFS and check with their regional MAC for any specific guidelines or coverage determinations that may apply.
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