CPT code 35641 is used to describe a surgical procedure for creating a bypass graft in an artery to improve blood flow.
CPT code 35641 is used to describe a surgical procedure known as an artery bypass graft. This procedure involves creating a new pathway for blood flow around a blocked or narrowed artery to improve circulation. It is typically performed to bypass diseased or damaged arteries, often in the legs, to restore adequate blood flow and alleviate symptoms such as pain or cramping. The graft can be made using a vein from another part of the patient's body or a synthetic material. This code is essential for accurately documenting and billing for the surgical services provided during the artery bypass graft procedure.
For CPT code 35641, which pertains to an artery bypass graft, the following modifiers may be applicable depending on the specific circumstances of the procedure and the payer requirements:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 51 - Multiple Procedures: Apply this modifier 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 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: Use this modifier 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 applicable when a complex procedure requires the services of a surgical team.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Use this modifier if the same procedure is repeated by the same provider on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when a procedure is repeated by a different provider 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: Use this modifier 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 modifier is used when a procedure performed during the postoperative period is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: Apply this modifier when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier when an assistant surgeon is required on a limited basis.
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.
13. Modifier 99 - Multiple Modifiers: Use this modifier when more than four modifiers are necessary to describe the service.
Each modifier should be used in accordance with the specific guidelines and payer policies to ensure proper billing and reimbursement.
CPT code 35641 is reimbursed by Medicare, but the reimbursement is subject to several factors. The Medicare Physician Fee Schedule (MPFS) is the primary tool used to determine the reimbursement rates for services covered under Medicare Part B, including those associated with CPT code 35641. The MPFS outlines the payment rates for each service, which are updated annually to reflect changes in practice costs, geographic adjustments, and other relevant factors.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to interpret national policies and establish local coverage determinations (LCDs) that may affect the reimbursement of specific CPT codes, including 35641. Therefore, while CPT code 35641 is generally reimbursed by Medicare, providers should verify the specific coverage and reimbursement details with their respective MAC to ensure compliance with any local policies or requirements.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including specific codes like 35641. Schedule a demo today to see how RevFind can help you maximize reimbursements and streamline your financial operations.
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
