CPT code 35558 is used for a surgical procedure involving an arterial bypass graft from one femoral artery to another.
CPT code 35558 is used to describe a surgical procedure known as an "arterial bypass graft from femoral to femoral artery." This procedure involves creating a bypass around a blocked or narrowed section of the femoral artery, which is a major blood vessel in the thigh. The bypass is typically created using a graft, which can be a piece of vein or synthetic material, to reroute blood flow from one femoral artery to the other, thereby improving circulation to the lower extremities. This code is crucial for healthcare providers to accurately document and bill for the procedure, ensuring proper reimbursement and maintaining the integrity of the patient's medical records.
For CPT code 35558, which pertains to arterial bypass grafting from femoral to femoral, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body during the same operative session.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is part of a series of operations.
3. Modifier 59 - Distinct Procedural Service: Utilized to indicate that the procedure is distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
5. Modifier 66 - Surgical Team: Applied when a complex procedure requires the expertise of a surgical team.
6. Modifier 76 - Repeat Procedure by Same Physician: Used if the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Used if the procedure is repeated by a different physician on the same day.
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: 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: Applied when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and 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.
CPT code 35558 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that outlines the payment rates for services covered under Medicare Part B, including surgical procedures like those associated with CPT code 35558. To determine if this specific code is reimbursed, healthcare providers should consult the MPFS to verify if the procedure is listed and to understand the associated payment rate.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that can affect whether a particular CPT code is reimbursed in their jurisdiction. Providers should check with their respective MAC to ensure that CPT code 35558 is covered and to understand any specific documentation or billing requirements that may apply.
In summary, while CPT code 35558 can be reimbursed by Medicare, providers must verify its inclusion in the MPFS and consult their MAC for any local coverage policies that might impact reimbursement.
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