CPT code 35525 is used for a surgical procedure involving an artery bypass graft from one brachial artery to another.
CPT code 35525 is used to describe a surgical procedure known as an "arterial bypass graft" specifically between the brachial artery to another brachial artery. This procedure involves creating a new pathway for blood flow around a blocked or narrowed section of the brachial artery, which is a major blood vessel in the arm. The bypass is typically constructed using a graft, which can be a piece of vein or synthetic material, to reroute blood flow and restore adequate circulation to the affected area. This code is utilized by healthcare providers to accurately document and bill for this specific type of vascular surgery.
For CPT code 35525, which pertains to an arterial bypass graft from brachial to brachial, 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 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 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, each surgeon should report their distinct operative work by adding this modifier.
5. Modifier 66 - Surgical Team: This is used when a team of surgeons is required to perform a complex procedure. Documentation should support the necessity of a team approach.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This is used when 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 used when the same 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 is used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: This is used when an assistant surgeon is required during the procedure.
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 is used when an assistant surgeon is required, and a qualified resident surgeon is not available.
13. Modifier 99 - Multiple Modifiers: This is used when two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used in accordance with the documentation and circumstances surrounding the procedure. Proper use of modifiers ensures accurate billing and reimbursement.
CPT code 35525 is subject to reimbursement by Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the specific Medicare Administrative Contractor (MAC) overseeing the region where the service is provided.
The MPFS outlines the payment rates for services covered under Medicare Part B, and CPT code 35525 must be listed there to be eligible for reimbursement.
Additionally, MACs have the authority to make determinations about coverage and reimbursement for specific services, which can vary by region.
Therefore, healthcare providers should verify the status of CPT code 35525 with their local MAC to ensure compliance and proper reimbursement.
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