CPT code 35612 is used for a surgical procedure involving an arterial bypass from one subclavian artery to another subclavian artery.
CPT code 35612 is used to describe a surgical procedure known as an "arterial bypass from subclavian to subclavian." This procedure involves creating a bypass between two subclavian arteries, which are major arteries located below the collarbone. The bypass is typically performed to reroute blood flow around a blocked or narrowed section of the artery, thereby restoring adequate blood circulation to the arm or other areas supplied by the subclavian artery. This code is essential for healthcare providers to accurately document and bill for the surgical intervention performed to address vascular issues in the subclavian arteries.
For CPT code 35612, which involves an arterial bypass from subclavian to subclavian, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body during the same operative session.
2. Modifier 51 - Multiple Procedures: If multiple procedures are 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 the procedure is distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
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 will share the work and reimbursement.
5. Modifier 66 - Surgical Team: This modifier is applicable when a highly complex procedure requires a surgical team, indicating that multiple professionals are involved in the procedure.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician on the same day, this modifier is used to indicate the repetition.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician 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 is used when 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 is unrelated to the original procedure.
Each modifier serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer policies to ensure accurate billing and reimbursement.
The CPT code 35612, which involves a specific procedure, is subject to reimbursement by Medicare, but this is contingent upon several factors. Primarily, the Medicare Physician Fee Schedule (MPFS) plays a crucial role in determining whether a particular CPT code is reimbursable. The MPFS outlines the payment rates for services and procedures covered under Medicare Part B, and it is updated annually to reflect changes in policy and practice.
To ascertain if CPT code 35612 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the associated reimbursement rate. Additionally, Medicare Administrative Contractors (MACs) are responsible for processing Medicare claims and can provide further guidance on coverage specifics. MACs may have local coverage determinations (LCDs) that affect whether certain procedures are reimbursed in specific regions.
Therefore, while CPT code 35612 may be reimbursed by Medicare, it is essential for healthcare providers to review the MPFS and consult with their respective MAC to confirm coverage and reimbursement details.
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