CPT code 35645 is used for a surgical procedure involving an arterial bypass from the subclavian to the vertebral artery.
CPT code 35645 is used to describe a surgical procedure involving an arterial bypass from the subclavian artery to the vertebral artery. This procedure is typically performed to improve blood flow to the brain by creating a new pathway for blood to travel, bypassing a blocked or narrowed section of the artery. It is a complex vascular surgery often indicated for patients with certain types of cerebrovascular insufficiency or other conditions affecting blood flow to the brain.
For CPT code 35645, which involves an arterial bypass from the subclavian to the vertebral artery, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body during the same operative session.
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 is 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: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are actively involved.
5. Modifier 66 - Surgical Team: This modifier is applicable when a team of surgeons is necessary to perform the procedure due to its complexity.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure on the same day, this modifier is used.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a different physician repeats the procedure 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: This is used if the 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.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier indicates their involvement.
11. 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.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific policies, as requirements can vary.
The CPT code 35645 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 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 can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) set forth by the MACs.
These contractors are responsible for processing Medicare claims and have the authority to establish specific coverage guidelines and payment rates for services within their jurisdiction. Therefore, it is crucial for healthcare providers to verify the reimbursement status of CPT code 35645 with their respective MAC to ensure compliance and accurate billing.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 35645, RevFind provides unparalleled insights into your revenue streams. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and enhance your financial performance.
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
