CPT code 35563 is used for a surgical procedure involving an arterial bypass graft between the iliac arteries.
CPT code 35563 is used to describe a surgical procedure known as an "arterial bypass graft" specifically between the iliac arteries. This procedure involves creating a bypass around a blocked or narrowed section of the iliac artery using a graft, which is often a segment of a vein or a synthetic material. The iliac arteries are major blood vessels in the pelvis that supply blood to the lower limbs. This bypass is performed to restore adequate blood flow to the affected areas, alleviating symptoms such as pain and improving overall circulation.
For CPT code 35563, which pertains to arterial bypass grafting from ilioiliac, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that increased the complexity of the surgery.
2. Modifier 51 - Multiple Procedures: If multiple procedures were performed during the same surgical session, this modifier indicates that more than one procedure was carried out.
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 particularly useful when procedures are not typically reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: If two surgeons were required to perform the procedure due to its complexity, this modifier indicates that each surgeon performed a distinct part of the surgery.
5. Modifier 66 - Surgical Team: Use this modifier when a team of surgeons is necessary to perform the procedure due to its complexity.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure, this modifier is used to indicate that the repeat procedure was necessary.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a different physician repeats the 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 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 it is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon was necessary for the procedure, this modifier indicates their involvement.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required on a minimal basis.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier when an assistant surgeon is necessary because 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. Always verify payer-specific guidelines, as the use of modifiers can vary.
The CPT code 35563 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used to reimburse physicians and other healthcare providers for services rendered to Medicare beneficiaries. Whether CPT code 35563 is reimbursed by Medicare depends on its inclusion in the MPFS and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) in your region.
MACs are private organizations contracted by Medicare to process claims and determine coverage specifics, including the reimbursement rates for various CPT codes. They have the authority to interpret national Medicare policies and apply them to local circumstances, which can affect whether a particular service, such as that represented by CPT code 35563, is reimbursed.
To determine if CPT code 35563 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and check with their local MAC for any additional coverage criteria or documentation requirements. This ensures compliance with Medicare's billing and reimbursement policies.
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