CPT code 35548 is used to identify a specific medical procedure involving an artery bypass graft, aiding in standardized communication among providers.
CPT code 35548 is used to describe a surgical procedure involving an artery bypass graft. This procedure is typically performed to reroute blood flow around a blocked or narrowed artery, thereby improving blood circulation to a specific area of the body. The graft can be made using a vein or synthetic material, and the goal is to restore adequate blood supply to tissues that are at risk due to compromised arterial flow. This code is crucial for accurate billing and documentation in the healthcare revenue cycle, ensuring that providers are reimbursed appropriately for the complex surgical services rendered.
For CPT code 35548, which pertains to an artery bypass graft, the following modifiers may be applicable. These modifiers are used to provide additional information about the procedure performed and to ensure accurate billing and reimbursement:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. 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.
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 used to identify procedures that are not normally reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure. Each surgeon must report the specific procedure(s) performed.
5. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the services of a surgical team. Documentation should support the necessity of a team approach.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by another physician or qualified healthcare professional subsequent to the original procedure.
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 patient requires a 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: This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to assist the primary surgeon during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
These modifiers help clarify the circumstances under which the procedure was performed and ensure that the healthcare provider receives appropriate reimbursement for the services rendered. Proper documentation is essential when using these modifiers to support the claims submitted.
CPT code 35548 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, the actual reimbursement can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) established by the MACs.
These contractors are responsible for interpreting national policies and setting regional guidelines, which can affect whether a particular service, such as one billed under CPT code 35548, is reimbursed and at what rate.
Therefore, it is crucial for healthcare providers to verify the specific coverage details with their local MAC to ensure compliance and accurate reimbursement for services rendered under this CPT code.
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 specific codes like 35548. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
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