CPT code 35585 is for a surgical procedure involving a vein bypass from the femoral to the tibial or peroneal artery.
CPT code 35585 is used to describe a surgical procedure where a vein bypass is performed from the femoral artery to the tibial or peroneal artery. This procedure is typically done to restore adequate blood flow to the lower leg and foot in patients with peripheral artery disease or other conditions that cause significant blockages in the arteries. The bypass involves using a vein, often harvested from the patient's own body, to create a new pathway for blood to flow around the blocked or narrowed section of the artery, thereby improving circulation and reducing symptoms such as pain or risk of tissue damage.
For CPT code 35585, which pertains to vein bypass from the femoral to the tibial or peroneal artery, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body during the same surgical session.
2. Modifier 51 - Multiple Procedures: This is applied 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 the procedure is distinct or independent from other services performed on the same day. It is used to prevent bundling of services that are typically considered part of a single procedure.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier is used to indicate that both surgeons are primary and are working together.
5. Modifier 66 - Surgical Team: This is used when a highly complex procedure requires the expertise of a surgical team.
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 is used when a procedure is repeated on the same day by a different physician.
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 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: This is used when an assistant surgeon is required to help with the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is necessary, and a qualified resident is not available.
These modifiers help in providing additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 35585, which involves a specific medical procedure, is subject to reimbursement considerations under Medicare. To determine if this code is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing claims and making coverage determinations based on local coverage determinations (LCDs) and national coverage determinations (NCDs). They may have specific guidelines or requirements that affect whether CPT code 35585 is reimbursed in a particular region.
Healthcare providers should verify the current status of CPT code 35585 in the MPFS and consult their respective MAC for any regional variations or additional documentation requirements that may impact reimbursement.
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