CPT code 35565 is used for a surgical procedure involving an arterial bypass graft from the iliac to the femoral artery.
CPT code 35565 is used to describe a surgical procedure known as an "artificial bypass graft for the iliofemoral artery." This procedure involves creating a bypass around a blocked or narrowed section of the iliofemoral artery, which is a major blood vessel in the pelvis that supplies blood to the lower limbs. The surgeon uses a graft, which can be made from synthetic materials or harvested from the patient's own body, to reroute blood flow around the obstructed area, thereby restoring adequate circulation to the affected leg. This code is essential for billing and documentation purposes, ensuring that healthcare providers are accurately reimbursed for the complex and specialized nature of this vascular surgery.
For CPT code 35565, which pertains to an arterial bypass graft involving the iliofemoral region, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:
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 used 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 services of a surgical team. It indicates that the procedure was performed by a team of surgeons.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by another physician or qualified healthcare professional subsequent to the original procedure or service.
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 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: This modifier is used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper documentation is essential to support the use of any modifier.
CPT code 35565 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) for your specific region.
The MPFS provides a comprehensive listing of fees used to reimburse physicians and other healthcare providers on a fee-for-service basis. Each MAC may have specific guidelines or local coverage determinations (LCDs) that influence whether CPT code 35565 is reimbursed and under what circumstances.
It is crucial for healthcare providers to verify the specific coverage criteria and reimbursement rates with their regional MAC to ensure compliance and accurate billing.
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