CPT code 35539 is used for a surgical procedure involving an aortofemoral artery bypass graft, aiding in the classification and documentation of healthcare services.
CPT code 35539 is used to describe a surgical procedure known as an aortofemoral artery bypass graft. This procedure involves creating a bypass around a blocked or narrowed section of the aorta or femoral artery using a graft. The graft, which can be made from synthetic material or a section of a vein from the patient's body, is used to reroute blood flow, improving circulation to the lower extremities. This code is specifically used for billing and documentation purposes to ensure accurate reimbursement for the healthcare provider performing the surgery.
For CPT code 35539, which involves an aortofemoral artery bypass graft, 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 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier indicates that the service was bilateral.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was performed.
4. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. 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.
6. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure, this modifier indicates that both surgeons were necessary due to the complexity of the procedure.
7. Modifier 66 - Surgical Team: This modifier is used when a team of surgeons is required to perform the procedure due to its complexity.
8. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure, this modifier is used to indicate the repetition.
9. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated by a different physician.
10. 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 the patient needs to return to the operating room for a related procedure during the postoperative period.
11. 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 physician during the postoperative period.
12. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help with the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: This modifier indicates that a minimum assistant surgeon was required for the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician practitioner assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always consult the latest coding guidelines and payer-specific requirements when applying modifiers.
CPT code 35539 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 specific guidelines set forth by the Medicare Administrative Contractor (MAC) for the region in which the service is provided.
The MPFS outlines the payment rates for services covered by Medicare, and each MAC may have additional local coverage determinations that affect reimbursement.
Therefore, it is crucial for healthcare providers to verify the specific reimbursement policies for CPT code 35539 with their respective MAC to ensure compliance and proper billing practices.
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