CPT code 35642 is used for a surgical procedure involving an arterial bypass from the carotid to the vertebral artery.
CPT code 35642 is used to describe a surgical procedure involving an arterial bypass from the carotid artery to the vertebral artery. This procedure is typically performed to improve blood flow to the brain when there is a blockage or narrowing in the arteries that supply blood to this critical area. By creating a bypass, the surgeon reroutes blood flow around the obstructed section, which can help prevent strokes or other complications related to reduced cerebral circulation. This code is essential for accurately documenting and billing for the procedure within the healthcare revenue cycle.
For CPT code 35642, which pertains to arterial bypass procedures involving the carotid and vertebral arteries, the following modifiers may be applicable:
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 is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several 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 used to identify procedures that are not normally reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, each surgeon should report their distinct operative work by adding this modifier.
5. Modifier 66 - Surgical Team: This is used when a complex procedure requires the services of several physicians, often of different specialties, working together as a team.
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 physician.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is used when the same procedure is repeated by a different physician.
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 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 is used when an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: This is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This is used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is required, and 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. Proper documentation is crucial when using modifiers to justify their necessity.
CPT code 35642 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 set forth by the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, the actual reimbursement for CPT code 35642 can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) established by the MACs.
These contractors have the authority to interpret Medicare policies and set specific guidelines for coverage in their jurisdictions. Therefore, it is essential for healthcare providers to consult the MPFS and their respective MAC to confirm the reimbursement status and any specific billing requirements for CPT code 35642.
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