CPT code 35646 is used for a surgical procedure involving an aortobifemoral artery bypass to improve blood flow in the lower body.
CPT code 35646 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 the femoral arteries, which are major blood vessels in the body. The bypass is typically constructed using a graft, which can be made from synthetic material or a section of a vein from the patient's body. This surgery is often performed to improve blood flow to the lower extremities in patients with peripheral artery disease (PAD) or other vascular conditions that restrict circulation. By rerouting the blood flow, the procedure aims to alleviate symptoms such as leg pain and improve the patient's overall mobility and quality of life.
For CPT code 35646, which involves an aortobifemoral bypass, the following modifiers may be applicable depending on the specific circumstances of the procedure:
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 unusual circumstances 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 conducted.
3. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the discretion of the physician.
4. 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.
5. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure, this modifier indicates that both surgeons are involved in the surgery.
6. Modifier 66 - Surgical Team: Use this modifier when a complex procedure requires a surgical team.
7. Modifier 76 - Repeat Procedure or Service by Same Physician: If the same physician needs to repeat the procedure, this modifier is applicable.
8. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated by a different physician.
9. 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 if the patient needs to return to the operating room for a related procedure during the postoperative period.
10. 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.
11. Modifier 80 - Assistant Surgeon: If an assistant surgeon is necessary for the procedure, this modifier should be used.
12. Modifier 81 - Minimum Assistant Surgeon: Use this modifier when a minimum assistant surgeon is required.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is applicable when an assistant surgeon is needed due to the unavailability of a qualified resident.
14. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary, this modifier indicates that multiple modifiers are being used.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
The CPT code 35646 is subject to reimbursement by Medicare, but its reimbursement status depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set by the Medicare Administrative Contractor (MAC) for the region where the service is provided.
The MPFS outlines the payment rates for services covered by Medicare, and each MAC may have additional local coverage determinations that influence whether a particular service is reimbursed.
Therefore, healthcare providers should verify the reimbursement status of CPT code 35646 by consulting the MPFS and the relevant MAC's policies to ensure compliance and accurate billing.
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