CPT code 35536 is used for a surgical procedure involving an arterial bypass graft between the splenic and renal arteries.
CPT code 35536 is used to describe a surgical procedure known as an "arterial bypass graft from the splenic artery to the renal artery." This code is utilized when a surgeon performs a bypass to redirect blood flow from the splenic artery to the renal artery, typically to improve blood supply to the kidneys. This procedure may be necessary in cases where there is a blockage or narrowing of the renal artery, which can affect kidney function. The use of this specific CPT code ensures accurate billing and documentation for the healthcare provider performing the surgery.
For CPT code 35536, which pertains to an arterial bypass graft involving the splenorenal area, 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 unusual anatomy or other complicating factors.
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.
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 a surgical team due to its complexity, this modifier is used to indicate that multiple professionals were involved.
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 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 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 modifier is used when an unrelated procedure is performed by the same provider during the postoperative period.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This is used when a minimal assistant surgeon is required.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary due to the unavailability of a qualified resident.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
The CPT code 35536 is subject to reimbursement considerations under Medicare, but its reimbursement status can vary based on several factors. To determine if CPT code 35536 is reimbursed by Medicare, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS), which provides detailed information on the payment rates for specific services covered by Medicare.
Additionally, it is important to check with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and may have specific local coverage determinations that affect reimbursement. These resources will provide the most accurate and up-to-date information regarding the reimbursement status of CPT code 35536 under Medicare.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including CPT code 35536, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
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
