CPT code 35638 is used for a surgical procedure involving an aortobi-iliac artery bypass to improve blood flow in patients with vascular disease.
CPT code 35638 is used to describe a surgical procedure known as an aortobifemoral bypass. This procedure involves creating a bypass around blocked or narrowed sections of the aorta and iliac arteries, which are major blood vessels in the abdomen and pelvis. The bypass is typically performed using a graft, which is a tube made of synthetic material or a vein from the patient's body, to reroute blood flow from the aorta to the iliac arteries, thereby improving circulation to the lower extremities. This code is specifically used for billing and documentation purposes to ensure accurate representation of the procedure performed.
When dealing with CPT code 35638, which pertains to an aortobi-iliac bypass procedure, 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 factors such as increased complexity or time.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was performed.
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 used to indicate the collaborative effort.
5. Modifier 66 - Surgical Team: If the procedure requires the expertise of a surgical team, this modifier is used to denote the involvement of multiple professionals.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier 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 modifier 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 an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
These modifiers help provide additional context to the billing and coding process, ensuring that the nuances of the procedure are accurately captured for reimbursement purposes. Proper use of modifiers is crucial for compliance and optimal revenue cycle management.
The CPT code 35638 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). Whether this code is reimbursed by Medicare depends on several factors, including its inclusion in the MPFS and the determination of coverage by the relevant Medicare Administrative Contractor (MAC) for your region.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. Each year, the Centers for Medicare & Medicaid Services (CMS) updates the MPFS, which includes the valuation of CPT codes like 35638. To determine if this specific code is reimbursed, providers should consult the latest MPFS to see if it is listed and what the associated reimbursement rate is.
Additionally, MACs play a crucial role in the reimbursement process. These contractors are responsible for processing Medicare claims and have the authority to make local coverage determinations (LCDs) that can affect whether a particular CPT code is reimbursed in their jurisdiction. Providers should check with their specific MAC to understand any local policies or requirements that might impact the reimbursement of CPT code 35638.
In summary, while CPT code 35638 may be included in the MPFS, its reimbursement by Medicare is contingent upon both its listing in the fee schedule and any specific guidelines or coverage determinations set forth by the applicable MAC.
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