CPT code 35546 is used for a surgical procedure involving an artery bypass graft, which helps improve blood flow around blocked arteries.
CPT code 35546 is used to describe a surgical procedure known as an artery bypass graft. This procedure involves creating a new pathway for blood flow around a blocked or narrowed artery, typically in the peripheral vascular system. The goal is to restore adequate blood circulation to the affected area, often the legs, by using a graft, which can be a vein or synthetic material, to bypass the obstructed section of the artery. This code is crucial for healthcare providers to accurately document and bill for the surgical intervention performed to treat conditions such as peripheral artery disease.
For CPT code 35546, which pertains to an artery bypass graft, the following modifiers may be applicable depending on the specific circumstances of the procedure and billing requirements:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that increased the complexity of the surgery.
2. Modifier 51 (Multiple Procedures): Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several 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): If two surgeons are required to perform the procedure due to its complexity, this modifier should be used to indicate that both surgeons are equally responsible for the procedure.
5. Modifier 66 (Surgical Team): Use this modifier when the procedure requires a surgical team due to its complexity, indicating that multiple professionals are involved in the surgery.
6. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used if the same procedure needs to be repeated by the same physician on the same day.
7. Modifier 77 (Repeat Procedure by Another Physician): Apply this modifier if the procedure is repeated by a different physician on the same day.
8. Modifier 78 (Unplanned Return to the Operating/Procedure Room): This modifier is used when a patient needs to 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): Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.
10. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required to help with the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): Apply this modifier when an assistant surgeon is required on a minimal basis.
12. Modifier 82 (Assistant Surgeon when Qualified Resident Surgeon Not Available): Use this modifier when an assistant surgeon is necessary because 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. Always verify payer-specific guidelines, as requirements for modifiers can vary.
CPT code 35546 is subject to reimbursement by Medicare, but its eligibility for payment 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) in your region.
The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates. However, the final determination of reimbursement is often influenced by the local coverage determinations (LCDs) and national coverage determinations (NCDs) established by the MACs.
These contractors are responsible for interpreting national Medicare policies and applying them to local contexts, which can affect whether a particular CPT code like 35546 is reimbursed. Therefore, it is crucial for healthcare providers to verify the specific coverage details with their regional MAC to ensure compliance and proper reimbursement for services rendered.
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