CPT code 35521 is used for a surgical procedure involving an arterial bypass graft from the axillary to the femoral artery.
CPT code 35521 is used to describe a surgical procedure known as an axillofemoral bypass graft. This procedure involves creating a bypass around blocked or narrowed arteries to restore adequate blood flow. Specifically, it connects the axillary artery, located near the armpit, to the femoral artery in the thigh. This type of bypass is typically performed to treat peripheral artery disease or other conditions that restrict blood flow to the lower extremities, helping to alleviate symptoms such as pain and improve overall limb function.
For CPT code 35521, which pertains to an axillofemoral artery bypass graft, 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 case.
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 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 that are not normally reported together but are appropriate under the circumstances.
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 used when a complex procedure requires the services of a surgical team.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by a different physician.
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 performed during the postoperative period is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is 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 due to the unavailability of a qualified resident surgeon.
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 the specific payer guidelines as they may have unique requirements for modifier usage.
CPT code 35521, which involves a specific procedure, is subject to reimbursement by Medicare, but this depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines whether a particular CPT code is reimbursable and at what rate. To ascertain if CPT code 35521 is reimbursed, healthcare providers should consult the MPFS to check if the code is listed and the associated reimbursement rate.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific guidance on coverage and reimbursement policies. They may have Local Coverage Determinations (LCDs) that affect whether CPT code 35521 is reimbursed in a particular area. Therefore, it is essential for healthcare providers to verify with their respective MACs to ensure compliance with any local policies that might impact reimbursement for this CPT code.
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