CPT code 35634 is used for a surgical procedure involving an arterial bypass from the iliac to the renal artery.
CPT code 35634 is used to describe a surgical procedure known as an "arterial bypass from the iliac artery to the renal artery." This procedure involves creating a bypass to redirect blood flow from the iliac artery, which is located in the pelvis, to the renal artery, which supplies blood to the kidneys. The bypass is typically performed to improve blood flow to the kidneys, often in cases where there is a blockage or narrowing in the renal artery that could lead to kidney dysfunction or hypertension. This code is utilized by healthcare providers to accurately document and bill for this specific type of vascular surgery.
For CPT code 35634, which involves an arterial bypass from the iliac to the renal artery, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or additional time and effort needed during the surgery.
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 was distinct or independent from other services performed on the same day. It may be necessary if the bypass is performed in conjunction with other procedures that are not typically reported together.
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 involved in the primary aspects of the surgery.
5. Modifier 66 - Surgical Team: When a surgical team is necessary to perform the procedure, this modifier is used to reflect the involvement of multiple professionals working together.
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: If the patient needs to return to the operating room for a related procedure during the postoperative period, this modifier is applicable.
7. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required to help with the procedure, this modifier is used to indicate their involvement.
8. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is present for a minimal portion of the procedure.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 35634 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. Primarily, the Medicare Physician Fee Schedule (MPFS) plays a crucial role in establishing the reimbursement rates for services covered under Medicare Part B. The MPFS outlines the payment amounts for each CPT code, including 35634, based on the relative value units (RVUs) assigned to the procedure, geographic location, and other factors.
Additionally, Medicare Administrative Contractors (MACs) are responsible for processing claims and determining the local coverage decisions for specific CPT codes. MACs may have specific guidelines or policies that affect whether CPT code 35634 is reimbursed in a particular region. Therefore, healthcare providers should consult the MPFS and their respective MAC's local coverage determinations to confirm the reimbursement status and any specific requirements for CPT code 35634.
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