CPT code 35626 is used for a surgical procedure involving an artery bypass from the aorta to the subclavian, carotid, or innominate artery.
CPT code 35626 is used to describe a surgical procedure involving an arterial bypass graft. Specifically, this code refers to the creation of a bypass from the aorta or subclavian artery to the carotid or innominate artery. This procedure is typically performed to improve blood flow in patients with significant arterial blockages or stenosis that cannot be treated with less invasive methods. The bypass helps reroute blood around the obstructed area, ensuring adequate circulation to critical areas such as the brain. 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 35626, which involves arterial bypass procedures, the following modifiers may be applicable. These modifiers are used to provide additional information about the performed procedure and ensure accurate billing and reimbursement:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 - Multiple Procedures: This modifier is applicable when multiple procedures are performed during the same surgical session. It indicates that the procedure is part of a series of procedures performed on the same day.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures that are not typically reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure. Each surgeon should report their distinct operative work.
5. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the services of a surgical team. It indicates that the procedure was performed by a team of surgeons due to its complexity.
6. 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 of the initial surgery.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure performed during the postoperative period is unrelated to the original procedure.
These modifiers help clarify the circumstances under which the procedure was performed and ensure that the billing accurately reflects the services provided. Proper use of modifiers can prevent claim denials and ensure appropriate reimbursement.
The CPT code 35626 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies of the local Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, the final decision on whether a specific CPT code like 35626 is reimbursed can vary based on the MAC's local coverage determinations (LCDs) and any additional guidelines they may have in place.
Therefore, healthcare providers should consult the MPFS and their respective MAC to confirm the reimbursement status and any specific requirements or documentation needed for CPT code 35626.
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