CPT code 35512 is used for a surgical procedure involving an arterial bypass graft from the subclavian to the brachial artery.
CPT code 35512 is used to describe a surgical procedure known as an "arterial bypass graft" from the subclavian artery to the brachial artery. This procedure involves creating a new pathway for blood flow by using a graft to bypass a blocked or narrowed section of the artery. The subclavian artery is located near the collarbone, and the brachial artery runs down the arm. This type of bypass is typically performed to restore adequate blood circulation to the arm when there is a blockage that impedes normal blood flow, often due to conditions like atherosclerosis.
For CPT code 35512, which pertains to an arterial bypass graft from the subclavian to the brachial 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. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It 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 used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure. Each surgeon should report their distinct operative work.
5. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the skills of several physicians, often of different specialties, working together as a team.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by another physician or qualified healthcare professional subsequent to the original procedure or service.
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 an unrelated procedure or service is performed by the same physician during the postoperative period.
Each of these modifiers serves a specific purpose and should be used in accordance with the clinical scenario and payer guidelines to ensure accurate billing and reimbursement. Proper documentation is essential to support the use of any modifier.
The CPT code 35512 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. Whether CPT code 35512 is reimbursed by Medicare depends on several factors, including its inclusion in the MPFS and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) responsible for the geographic region where the service is provided.
Each MAC has the authority to interpret national Medicare policies and establish local coverage determinations (LCDs) that can affect the reimbursement of specific CPT codes. Therefore, healthcare providers should consult the MPFS and their respective MAC's guidelines to determine the reimbursement status of CPT code 35512. Additionally, providers should ensure that all necessary documentation and medical necessity criteria are met to facilitate successful reimbursement.
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