CPT code 35632 is used for a surgical procedure involving an arterial bypass from the iliac artery to the celiac artery.
CPT code 35632 is used to describe a surgical procedure known as an "arterial bypass from the iliac artery to the celiac artery." This procedure involves creating a bypass to reroute blood flow from the iliac artery, which is located in the pelvis, to the celiac artery, which supplies blood to the stomach, liver, and other abdominal organs. This type of bypass is typically performed to improve blood flow in cases where there is a blockage or narrowing in the arteries that could compromise the blood supply to vital organs. The procedure is complex and requires the expertise of a vascular surgeon.
For CPT code 35632, which pertains to arterial bypass procedures, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used, along with the reasons for their application:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to increased complexity or additional time spent.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was conducted.
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 often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is applicable.
5. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires a surgical team, indicating that multiple professionals are involved in the surgery.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This is used when the same procedure is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by a different provider.
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 a 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 modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This indicates that a minimum assistant surgeon was necessary for the procedure.
12. 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.
13. Modifier 99 - Multiple Modifiers: When two or more modifiers are necessary to describe the service provided, this modifier is used to indicate multiple modifiers.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It's important to review the specific guidelines and payer policies when applying these modifiers.
The CPT code 35632 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that outlines the payment rates for services covered by Medicare. To determine if CPT code 35632 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 significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make coverage decisions based on local coverage determinations (LCDs). Therefore, it is essential for healthcare providers to check with their specific MAC to confirm if CPT code 35632 is covered and reimbursed in their region, as coverage can vary based on local policies and guidelines.
In summary, while CPT code 35632 may be reimbursed by Medicare, providers must verify its inclusion in the MPFS and consult their MAC for specific coverage details and reimbursement eligibility.
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