CPT code 35526 is used for a surgical procedure involving an arterial bypass graft from the aorta to the carotid or innominate artery.
CPT code 35526 is used to describe a surgical procedure involving an arterial bypass graft. Specifically, this code pertains to the creation of a bypass graft between the aorta and either the carotid artery or the innominate artery. This procedure is typically performed to improve blood flow in patients with significant arterial blockages or narrowing, which can lead to conditions such as stroke or other vascular complications. The bypass graft serves as an alternative pathway for blood to travel, circumventing the obstructed or narrowed section of the artery.
For CPT code 35526, which pertains to arterial bypass grafting involving the aorta, carotid, or innominate arteries, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 51 - Multiple Procedures: Apply this modifier 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 is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier should be used to indicate the shared responsibility.
5. Modifier 66 - Surgical Team: Use this modifier when the procedure requires a surgical team due to its complexity, indicating that multiple professionals are involved.
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: Apply this modifier 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 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: Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial 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: Apply this when a minimum assistant surgeon is needed for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this 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 payer-specific guidelines, as modifier usage can vary between insurance carriers.
The CPT code 35526 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, the final decision on whether a specific CPT code like 35526 is reimbursed can also depend on local coverage determinations (LCDs) made by the MAC, which may vary based on geographic location and specific medical necessity criteria.
Therefore, it is crucial for healthcare providers to verify the reimbursement status of CPT code 35526 with their respective MAC to ensure compliance and accurate billing.
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