CPT code 35515 is used for a surgical procedure involving an arterial bypass graft from the subclavian to the vertebral artery.
CPT code 35515 is used to describe a surgical procedure involving an arterial bypass graft from the subclavian artery to the vertebral artery. This procedure is typically performed to improve blood flow to the brain by bypassing a blocked or narrowed section of the artery. The subclavian artery, located near the collarbone, is connected to the vertebral artery, which supplies blood to the brain, through a graft. This code is essential for healthcare providers to accurately document and bill for this specific type of vascular surgery.
For CPT code 35515, which involves an arterial bypass graft from the subclavian to the vertebral 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 unusual anatomy or complications that arise during the procedure.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that additional procedures were carried out.
3. Modifier 59 - Distinct Procedural Service: This 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 applicable.
5. Modifier 66 - Surgical Team: If the procedure requires a surgical team due to its complexity, this modifier is used to indicate that a team approach was necessary.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used if the same procedure is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is applicable when the procedure is repeated by a different provider.
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 if there is a need to 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 indicates that a procedure performed during the postoperative period was unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier is used.
11. Modifier 81 - Minimum Assistant Surgeon: This is used when an assistant surgeon is required for a minimal portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is applicable when an assistant surgeon is necessary due to the unavailability of a qualified resident.
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 35515 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource for determining if a specific CPT code is reimbursed by Medicare. The MPFS outlines the payment rates for services and procedures covered by Medicare, including any applicable geographic adjustments.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make determinations about coverage and reimbursement for specific CPT codes within their jurisdiction. They may issue Local Coverage Determinations (LCDs) that provide guidance on whether a particular service, such as one billed under CPT code 35515, is covered.
To ascertain if CPT code 35515 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and check with their respective MAC for any local coverage policies or guidelines that may affect reimbursement. This ensures that providers are aware of any specific requirements or documentation needed to secure reimbursement for this code.
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