CPT code 35583 is used for a surgical procedure involving a vein bypass graft from the femoral to the popliteal artery.
CPT code 35583 is used to describe a surgical procedure involving a vein bypass graft from the femoral artery to the popliteal artery. This procedure is typically performed to bypass a blocked or narrowed section of the femoral or popliteal artery, which can improve blood flow to the lower leg and foot. The use of a vein graft, often harvested from the patient's own body, helps to reroute blood around the obstructed area, thereby alleviating symptoms such as pain and improving overall limb function. This code is crucial for accurate billing and documentation in the healthcare revenue cycle, ensuring that providers are reimbursed appropriately for the complex surgical services rendered.
For CPT code 35583, which pertains to a vein 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 the left and right sides during the same surgical session.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that the procedure is one of several.
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: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are involved in the operation.
5. Modifier 66 - Surgical Team: When a surgical team is necessary to perform the procedure, this modifier is used to denote the involvement of multiple professionals.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure on the same day, this modifier is used.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a different physician repeats the procedure 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: 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: 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 is required to help with the procedure, this modifier is used.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 35583 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. However, the actual reimbursement for CPT code 35583 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for interpreting national policies and setting local coverage determinations, which can influence whether and how a particular service is reimbursed. Therefore, healthcare providers should consult their specific MAC for detailed information on the reimbursement criteria and rates for CPT code 35583.
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