CPT code 35556 is used for a surgical procedure involving an arterial bypass graft from the femoral to the popliteal artery.
CPT code 35556 is used to describe a surgical procedure known as an "arterial bypass graft from the femoral to the popliteal artery." This procedure involves creating a bypass around a blocked or narrowed section of the femoral artery, which is located in the thigh, to the popliteal artery, located behind the knee. The bypass is typically created using a graft, which can be a piece of vein or synthetic material, to restore proper blood flow to the lower leg and foot. This procedure is often performed to treat peripheral artery disease (PAD) and improve circulation in the affected limb.
For CPT code 35556, which pertains to an arterial bypass graft from the femoral to the popliteal artery, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body during the same operative session.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was performed.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is applicable.
5. Modifier 66 - Surgical Team: If the procedure requires a surgical team due to its complexity, this modifier is used.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier is applicable.
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 if the 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: If an unrelated procedure is performed by the same physician during the postoperative period, this modifier is used.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is necessary, and a qualified resident is not available.
These modifiers help in accurately reporting the circumstances under which the procedure was performed, ensuring proper billing and reimbursement.
CPT code 35556 is associated with a specific medical procedure, and whether it is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the Medicare Administrative Contractor (MAC) in your region.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. If CPT code 35556 is listed in the MPFS, it indicates that Medicare has established a reimbursement rate for this procedure, subject to any applicable conditions or limitations.
However, the final determination of reimbursement also involves the MAC, which is responsible for processing Medicare claims and making coverage decisions based on national and local policies. Each MAC may have specific guidelines or requirements that could affect the reimbursement of CPT code 35556.
To confirm whether CPT code 35556 is reimbursed by Medicare, healthcare providers should consult the latest MPFS and contact their regional MAC for any specific coverage criteria or documentation requirements. This ensures compliance with Medicare's billing and reimbursement policies.
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