CPT code 35587 is used for a surgical procedure involving a vein bypass from the popliteal to the tibial or peroneal artery.
CPT code 35587 is used to describe a surgical procedure involving a vein bypass graft to the popliteal-tibial or peroneal artery. This code is specifically for procedures where a vein is used to create a bypass around a blocked or narrowed section of these arteries, which are located in the lower leg. The goal of this procedure is to restore adequate blood flow to the affected area, often to alleviate symptoms of peripheral artery disease or to prevent limb loss. This code is crucial for accurate billing and documentation of the specific type of vascular surgery performed.
For CPT code 35587, which involves a vein bypass procedure from the popliteal 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 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 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.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier is used to indicate the involvement of both surgeons.
5. Modifier 66 - Surgical Team: When a surgical team is necessary to perform the procedure, this modifier is applied to indicate 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 if an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier is used to indicate their involvement.
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. Always verify payer-specific guidelines, as modifier usage can vary.
The CPT code 35587 is subject to reimbursement by Medicare, but its reimbursement is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines the payment rates for services covered by Medicare. To ascertain if CPT code 35587 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the associated payment rate.
Additionally, Medicare Administrative Contractors (MACs) play a pivotal role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies for CPT code 35587. Since MACs may have localized policies or interpretations, it is advisable for healthcare providers to check with their respective MAC to ensure compliance with any regional requirements or documentation needs that could affect reimbursement.
Therefore, while CPT code 35587 can be reimbursed by Medicare, providers must verify its inclusion in the MPFS and consult their MAC for any additional requirements or clarifications to ensure successful reimbursement.
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