CPT code 35522 is a procedure code for an arterial bypass graft from the axillary to the brachial artery, used for medical documentation.
CPT code 35522 is used to describe a surgical procedure known as an axillobrachial artery bypass graft. This procedure involves creating a bypass around a blocked or narrowed section of the artery that runs from the axilla (armpit area) to the brachial artery in the arm. The bypass is typically constructed using a graft, which can be a section of a vein or a synthetic material, to restore proper blood flow to the arm. This code is essential for accurately documenting and billing for the procedure within the healthcare revenue cycle.
For CPT code 35522, which pertains to an arterial bypass graft from the axillary to the brachial artery, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body during the same operative session.
2. Modifier 51 - Multiple Procedures: This is applicable 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 the procedure is distinct or independent from other services performed on the same day. It may be necessary if the procedure is performed in a different session or on a different site.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier is used to indicate the involvement of both surgeons.
5. Modifier 66 - Surgical Team: This modifier is applicable when the procedure requires a surgical team due to its complexity.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure on the same day, this modifier is used.
7. Modifier 77 - Repeat Procedure by Another Physician: This is used when a different physician repeats the procedure 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 if the patient needs 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 is used when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required to help with the procedure, this modifier is used.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is necessary, and a qualified resident is not available.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 35522 is subject to reimbursement by Medicare, but several factors influence whether it will be covered. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in determining the reimbursement rates for services provided under this code. The MPFS outlines the payment amounts for each CPT code, including 35522, based on the relative value units (RVUs) assigned to the service, geographic location adjustments, and conversion factors.
However, the final decision on reimbursement also depends on the policies of the Medicare Administrative Contractor (MAC) that processes claims in your specific region. MACs have the authority to establish local coverage determinations (LCDs) that may affect whether CPT code 35522 is reimbursed. These LCDs can include specific criteria that must be met for the service to be considered medically necessary and, therefore, eligible for reimbursement.
Healthcare providers should verify the MPFS for the current year and consult their regional MAC's guidelines to ensure compliance with any local coverage requirements when billing for CPT code 35522.
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