CPT code 35623 is used for a surgical procedure involving an arterial bypass from the axillary artery to the popliteal or tibial artery.
CPT code 35623 is used to describe a surgical procedure known as an "axillary-popliteal-tibial artery bypass." This procedure involves creating a bypass graft to reroute blood flow around blocked or narrowed arteries in the lower extremities. Specifically, it connects the axillary artery, located near the shoulder, to the popliteal artery behind the knee, and extends to the tibial artery in the lower leg. This type of bypass is typically performed to restore adequate blood circulation to the leg and foot, often in patients with severe peripheral artery disease (PAD) or critical limb ischemia. The goal is to alleviate symptoms such as pain and to prevent complications like ulcers or gangrene.
For CPT code 35623, which pertains to a specific surgical procedure, the following modifiers may be applicable depending on the circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: This modifier is used when the procedure is performed on both sides of the body during the same operative session.
2. Modifier 51 - Multiple Procedures: This is applied when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was 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 often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
5. Modifier 66 - Surgical Team: This is applicable when a complex procedure requires the expertise of a surgical team.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This 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 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 is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial 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 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 necessary due to the unavailability of a qualified resident surgeon.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This is used when these non-physician practitioners assist in the surgery.
Each modifier serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies to ensure accurate billing and reimbursement.
The CPT code 35623 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered.
Whether CPT code 35623 is reimbursed by Medicare depends on its inclusion in the MPFS and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) in your region. MACs are responsible for processing Medicare claims and have the authority to interpret national policies and make local coverage determinations.
Therefore, it is essential to consult the MPFS and your local MAC to confirm if CPT code 35623 is reimbursed and to understand any specific billing requirements or limitations that may apply.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 35623, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
