CPT code 35549 is used to describe a surgical procedure for an artery bypass graft, helping streamline communication and documentation in healthcare.
CPT code 35549 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, often in the lower extremities, to improve circulation. The graft can be created using a vein from another part of the patient's body or a synthetic material. This code is crucial for accurately documenting the procedure for billing and insurance purposes, ensuring that healthcare providers are reimbursed for the specific services rendered.
For CPT code 35549, 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 applicable 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 should report their distinct operative work.
5. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the skills 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 the same procedure is repeated by the same provider subsequent to the original procedure.
7. 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.
8. 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 of the initial procedure.
These modifiers help in providing clarity and specificity to the billing process, ensuring that the healthcare provider is accurately reimbursed for the services rendered. Proper documentation is essential when using these modifiers to support the necessity and appropriateness of their application.
CPT code 35549 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 policies 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 final decision on whether CPT code 35549 is reimbursed can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) established by the MAC.
It is essential for healthcare providers to verify the specific guidelines and reimbursement rates with their respective MAC to ensure compliance and proper billing practices.
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