CPT code 35535 is used for a surgical procedure involving an arterial bypass graft between the hepatic and renal arteries.
CPT code 35535 is used to describe a surgical procedure known as an "arterial bypass graft for hepatorenal bypass." This procedure involves creating a bypass using a graft to redirect blood flow from the hepatic artery to the renal artery. It is typically performed to improve blood circulation to the kidneys when there is a blockage or narrowing in the normal blood flow pathway. This code is utilized by healthcare providers to accurately document and bill for this specific type of vascular surgery.
For CPT code 35535, which involves an arterial bypass graft for hepatorenal purposes, 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 unexpected findings during 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 conducted.
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 particularly relevant if the bypass graft is performed in conjunction with other procedures that are not typically bundled together.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are actively involved and each is performing a distinct part of the procedure.
5. Modifier 66 - Surgical Team: This modifier is applicable when a highly complex procedure requires the skills of several physicians, often from different specialties, working together as a team.
6. 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.
7. Modifier 80 - Assistant Surgeon: If an assistant surgeon is necessary for the procedure, this modifier indicates their involvement.
8. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Similar to Modifier 80, but specifically used when a qualified resident surgeon is not available.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It's important for healthcare providers to carefully assess the need for each modifier based on the specifics of the surgical procedure and the patient's condition.
The CPT code 35535 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that outlines the payment rates for services covered under Medicare Part B, including surgical procedures. To determine if CPT code 35535 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the associated reimbursement rate.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make local coverage determinations (LCDs) that can affect whether a specific CPT code, such as 35535, is reimbursed in their jurisdiction. Providers should check with their respective MAC to ensure that CPT code 35535 is covered and to understand any specific documentation or billing requirements that may apply.
In summary, while CPT code 35535 can be reimbursed by Medicare, providers must verify its inclusion in the MPFS and consult their MAC for any additional coverage criteria or requirements.
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