CPT code 35540 is used for a surgical procedure involving an aortobifemoral artery bypass graft to improve blood flow in the lower body.
CPT code 35540 is used to describe a surgical procedure known as an aortobifemoral bypass graft. This procedure involves creating a bypass around blocked or narrowed sections of the aorta and the femoral arteries, which are major blood vessels in the body. The surgeon uses a graft, which can be a synthetic tube or a section of a vein from the patient's body, to reroute blood flow from the aorta to the femoral arteries. This helps restore adequate blood circulation to the lower extremities, often necessary for patients with severe peripheral artery disease.
For CPT code 35540, which pertains to an aortobifemoral 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 complications or additional work that is not usually part of the procedure.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed bilaterally, this modifier should be used to indicate that the procedure was performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
4. Modifier 52 - Reduced Services: This modifier is applicable 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 each surgeon is performing a distinct part of the procedure.
7. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the services of a surgical team.
8. Modifier 76 - Repeat Procedure by Same Physician: If the procedure needs to be repeated by the same physician, this modifier is used to indicate the repeat service.
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 a patient requires a 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 for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is 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 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 35540 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 policies of the Medicare Administrative Contractor (MAC) that governs the region where the service is provided.
The MPFS provides a list of services covered by Medicare and assigns relative value units (RVUs) to each service, which are used to determine reimbursement rates. However, the final decision on reimbursement can also be influenced by local coverage determinations (LCDs) set by the MACs, which may have specific guidelines or requirements for coverage.
Therefore, healthcare providers should verify the reimbursement status of CPT code 35540 with their local MAC and ensure compliance with any applicable LCDs to secure Medicare reimbursement.
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