CPT code 35560 is used for a surgical procedure involving an aortorenal artery bypass graft to improve blood flow to the kidneys.
CPT code 35560 is used to describe a surgical procedure known as an aortorenal bypass graft. This procedure involves creating a bypass around a blocked or narrowed section of the aorta to restore adequate blood flow to the renal arteries, which supply blood to the kidneys. The bypass is typically constructed using a graft, which can be made from synthetic material or a section of the patient's own blood vessel. This code is essential for accurately documenting and billing for the procedure, ensuring that healthcare providers are reimbursed appropriately for their services.
For CPT code 35560, which involves an aortorenal artery bypass graft, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was conducted.
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 typically reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is used to indicate the collaborative effort.
5. Modifier 66 - Surgical Team: This modifier is applicable when a complex procedure requires the services of a surgical team, indicating that multiple professionals are involved in the procedure.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This is used when the same procedure is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when a procedure is repeated by a different provider.
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 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: This modifier is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review the specific guidelines and payer policies when applying these modifiers to ensure compliance and proper claims processing.
CPT code 35560 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 by the Medicare Administrative Contractor (MAC) for 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 for CPT code 35560 can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) established by the MACs.
These contractors have the authority to interpret Medicare policy and decide whether a particular service is covered in their jurisdiction. Therefore, it is essential for healthcare providers to consult their local MAC for specific guidance on the reimbursement status of CPT code 35560.
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