CPT code 35533 is used for a surgical procedure involving an arterial bypass graft from the axillary to femoral or femoral artery.
CPT code 35533 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 axillary artery and the femoral artery, or between two femoral arteries. This procedure is typically performed to reroute blood flow around a blocked or narrowed artery, thereby improving circulation to the lower extremities. It is a complex operation often indicated for patients with severe peripheral artery disease or other vascular conditions that impede blood flow to the legs.
For CPT code 35533, which involves arterial bypass grafting from the axillary to femoral or femoral, 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 procedure.
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 shared responsibility.
5. Modifier 66 - Surgical Team: This modifier is applicable 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 provider.
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 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 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 during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier 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 modifier is used when an assistant surgeon is required and a qualified resident surgeon is not available.
These modifiers help in accurately describing the circumstances under which the procedure was performed, ensuring appropriate billing and reimbursement.
The CPT code 35533 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) for the region where the service is provided.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. If CPT code 35533 is listed on the MPFS, it indicates that Medicare has established a reimbursement rate for this service, subject to any applicable conditions or limitations.
However, the final determination of reimbursement also involves the MAC, which is responsible for processing Medicare claims and ensuring compliance with Medicare policies in specific geographic areas. Each MAC may have unique coverage policies or additional documentation requirements that can affect whether CPT code 35533 is reimbursed.
Healthcare providers should verify the inclusion of CPT code 35533 in the MPFS and consult with their local MAC to understand any specific coverage criteria or pre-authorization requirements that may impact reimbursement. This ensures accurate billing and maximizes the likelihood of successful reimbursement from Medicare.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 35533, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
