CPT code 35523 is for a surgical procedure involving an arterial bypass graft from the brachial to the ulnar or radial artery.
CPT code 35523 is used to describe a surgical procedure involving an arterial bypass graft from the brachial artery to the ulnar or radial artery. This procedure is typically performed to restore adequate blood flow to the arm or hand when there is a blockage or narrowing in the arteries. The graft, which can be made from a vein or synthetic material, is used to reroute blood around the obstructed section, thereby improving circulation and alleviating symptoms associated with poor blood flow.
For CPT code 35523, which pertains to an arterial bypass graft involving the brachial, ulnar, and radial arteries, 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 complications or other factors that increase the complexity of the surgery.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was performed. It helps in the correct allocation of reimbursement for each procedure.
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 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 used to indicate the collaborative effort.
5. Modifier 66 - Surgical Team: If the procedure requires the expertise of a surgical team, this modifier is used to reflect the complexity and necessity of multiple professionals working together.
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 provider, indicating that the repetition was necessary.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Similar to Modifier 76, but used when the repeat procedure is performed 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 when a 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: This modifier is used when an assistant surgeon is required to help with the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: 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 is used when an assistant surgeon is necessary because a qualified resident is not available.
These modifiers help in accurately describing the circumstances under which the procedure was performed, ensuring proper billing and reimbursement. It is important to use them correctly to avoid claim denials and ensure compliance with payer policies.
CPT code 35523 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set by the Medicare Administrative Contractor (MAC) in your region.
The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. However, each MAC has the authority to interpret and implement Medicare policies, which can affect the reimbursement status of specific CPT codes like 35523.
Therefore, it is crucial for healthcare providers to verify the reimbursement status of CPT code 35523 with their local MAC to ensure compliance and proper billing practices.
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